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Aspirin interruption before neurosurgical interventions:A controversial problem

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World Journal of Cardiology 2024年第4期16卷 191-198页

作者： Alexander Kulikov Anton Konovalov Pier Paolo Pugnaloni Federico Bilotta department of anesthesiology Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia department of Vascular Neurosurgery Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia department of anesthesiology Critical Care and Pain MedicineUniversity of Rome“Sapienza”Rome 00161Italy

Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.

关键词： Aspirin Neurosurgery Postoperative complications Bleeding risk Brain tumor surgery Cerebrovascular surgery Spinal surgery

Ultrasound-guided sphenopalatine ganglion block for effective analgesia during awake fiberoptic nasotracheal intubation: A case report

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World Journal of Clinical Cases 2024年第14期12卷 2451-2456页

作者： Hangil Kang Seongjae Park Yehun Jin department of anesthesiology and Pain Medicine National Cancer CenterGoyang-si 10408Gyeonggi-doSouth Korea

BACKGROUND Awake fiberoptic nasotracheal intubation(AFNI)is the preferred airway ma-nagement strategy for patients with difficult airways.However,this procedure can cause significant physical and psychological distress.This case report explores the application of a sphenopalatine ganglion(SPG)block as an alternative anal-gesic modality to mitigate the discomfort associated with AFNI.CASE SUMMARY A 63-year-old female with a history of right maxillary osteosarcoma underwent craniotomy for a suspected malignant brain lesion.The patient’s medical history included prior surgery,chemotherapy,and radiation therapy,resulting in signi-ficant jaw impairment and limited neck mobility.Considering the anticipated air-way challenges,AFNI was planned.A SPG block was performed under real-time ultrasound guidance,providing effective analgesia during nasotracheal intuba-tion.CONCLUSION The SPG block represents a promising analgesic approach in AFNI,offering po-tential benefits in alleviating pain involving the nasal and nasopharyngeal regions as well as improving patient cooperation.

关键词： Sphenopalatine ganglion block Nerve block Regional anesthesia Analgesia Awake fiberoptic nasotracheal intubation Case report

Hypoxia upregulates hypoxia inducible factor(HIF)-3α expression in lung epithelial cells: characterization and comparison with HIF-1α

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Cell Research 2006年第6期16卷 548-558页

作者： Qi Fang Li~1 Xiang Rui Wang~1 Yue Wu Yang~1 Han Lin~1 ~1department of anesthesiology,Renji Hospital,Shanghai Second Medical University,1630 Dongfang Road,Shanghai 200127,China department of anesthesiology Renji Hospital Shanghai Second Medical University Shanghai China

The role of the hypoxia-inducible factor(HIF)subunits 1α and 2α in response to hypoxia is well established in lungepithelial cells,whereas little is known about HIF-3α with respect to transcriptional and translational regulation by hy-poxia.HIF-3α and HIF-1α are two similar but distinct basic helix-loop-helix-PAS proteins,which have been postulatedto activate hypoxia responsive genes in response to hypoxia.Here,we used quantitative real time RT-PCR and immu-noblotting to determine the activation of HIF-3α vs.HIF-1α by hypoxia.HIF-3α was strongly induced by hypoxia(1%O)both at the level of protein and mRNA due to an increase in protein stability and transcriptional activation,whereasHIF-1α protein and mRNA levels enhanced transiently and then decreased because of a reduction in its mRNA stabilityin A549 cells,as measured on mRNA and protein levels.Interestingly,HIF-3α and HIF-1α exhibited strikingly similarresponses to a variety of activating or inhibitory pharmacological agents.These results demonstrate that HIF-3α is ex-pressed abundantly in lung epithelial cells,and that the transcriptional induction of HIF-3α plays an important role in theresponse to hypoxia in vitro.Our findings suggest that HIF-3α,as a member of the HIF system,is complementary ratherthan redundant to HIF-1α induction in protection against hypoxic damage in alveolar epithelial cells.

关键词： hypoxia inducible factor alveolar epithelial type Ⅱ cells hypoxia gene expression in vitro

Effect of transcranial direct current stimulation on postoperative sleep disturbance in older patients undergoing lower limb major arthroplasty:a prospective,double-blind,pilot,randomised controlled trial

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General Psychiatry 2024年第2期37卷 224-233页

作者： Jie Yang Mingshu Tao Rongguang Liu Jiaxing Fang Chunyan Li Dexian Chen Qi Wei Xingyu Xiong Wenxin Zhao Wen Tan Yuan Han Hongxing Zhang He Liu Song Zhang Junli Cao department of anesthesiology The Affiliated Hospital of Xuzhou Medical UniversityXuzhouJiangsuChina department of anesthesiology Hospital of Chengdu University of Traditional Chinese Medicine&Traditional Chinese Medicine Hospital of Sichuan ProvinceChengduSichuanChina NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs&Jiangsu Province Key Laboratory of anesthesiology&Jiangsu Key Laboratory of Applied Technology of Anesthesia and Analgesia Xuzhou Medical UniversityXuzhouJiangsuChina department of anesthesiology Eye&ENT Hospital of Fudan UniversityShanghaiChina department of anesthesiology&Clinical Research Center for Anesthesia and Perioperative Medicine&Huzhou Key Laboratory of Basic Research and Clinical Translation for Neuromodulation The Fifth School of Clinical Medicine of Zhejiang Chinese Medical University||Huzhou Central Hospital||The Affiliated Huzhou HospitalZhejiang University School of Medicine||Affiliated Central Hospital Huzhou UniversityHuzhouZhejiangChina department of anesthesiology Renji Hospital School of MedicineShanghai Jiao Tong UniversityShanghaiChina

Background Postoperative sleep disturbance(PSD)is a common and serious postoperative complication and is associated with poor postoperative outcomes.Aims This study aimed to investigate the effect of transcranial direct current stimulation(tDCS)on PSD in older patients undergoing lower limb major arthroplasty.Methods In this prospective,double-blind,pilot,randomised,sham-controlled trial,patients 65 years and over undergoing lower limb major arthroplasty were randomly assigned to receive active tDCS(a-tDCS)or sham tDCS(s-tDCS).The primary outcomes were the objective sleep measures on postoperative nights(N)1 and N2.Results 116 inpatients were assessed for eligibility,and a total of 92 patients were enrolled;47 received a-tDCS and 45 received s-tDCS.tDCS improved PSD by altering the following sleep measures in the a-tDCS and s-tDCS groups;the respective comparisons were as follows:the promotion of rapid eye movement(REM)sleep time on N1(64.5(33.5-105.5)vs 19.0(0.0,45.0)min,F=20.10,p<0.001)and N2(75.0(36.0-120.8)vs 30.0(1.3-59.3)min,F=12.55,p<0.001);the total sleep time on N1(506.0(408.0-561.0)vs 392.0(243.0-483.5)min,F=14.13,p<0.001)and N2(488.5(455.5-548.5)vs 346.0(286.5-517.5)min,F=7.36,p=0.007);the deep sleep time on N1(130.0(103.3-177.0)vs 42.5(9.8-100.8)min,F=24.4,p<0.001)and N2(103.5(46.0-154.8)vs 57.5(23.3-106.5)min,F=8.4,p=0.004);and the percentages of light sleep and REM sleep on N1 and N2(p<0.05 for each).The postoperative depression and anxiety scores did not differ significantly between the two groups.No significant adverse events were reported.Conclusion In older patients undergoing lower limb major arthroplasty,a single session of anodal tDCS over the left dorsolateral prefrontal cortex showed a potentially prophylactic effect in improving postoperative short-term objective sleep measures.However,this benefit was temporary and was not maintained over time.

关键词： sleep stimulation postoperative

Infiltration by monocytes of the central nervous system and its role in multiple sclerosis: reflections on therapeutic strategies

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Neural Regeneration Research 2025年第3期20卷 779-793页

作者： Guangyong Zhang Qing Yao Chubing Long Pengcheng Yi Jiali Song Luojia Wu Wei Wan Xiuqin Rao Yue Lin Gen Wei Jun Ying Fuzhou Hua department of anesthesiology the Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina Key Laboratory of anesthesiology of Jiangxi Province NanchangJiangxi ProvinceChina

Mononuclear macrophage infiltration in the central nervous system is a prominent feature of neuroinflammation. Recent studies on the pathogenesis and progression of multiple sclerosis have highlighted the multiple roles of mononuclear macrophages in the neuroinflammatory process. Monocytes play a significant role in neuroinflammation, and managing neuroinflammation by manipulating peripheral monocytes stands out as an effective strategy for the treatment of multiple sclerosis, leading to improved patient outcomes. This review outlines the steps involved in the entry of myeloid monocytes into the central nervous system that are targets for effective intervention: the activation of bone marrow hematopoiesis, migration of monocytes in the blood, and penetration of the blood–brain barrier by monocytes. Finally, we summarize the different monocyte subpopulations and their effects on the central nervous system based on phenotypic differences. As activated microglia resemble monocyte-derived macrophages, it is important to accurately identify the role of monocyte-derived macrophages in disease. Depending on the roles played by monocyte-derived macrophages at different stages of the disease, several of these processes can be interrupted to limit neuroinflammation and improve patient prognosis. Here, we discuss possible strategies to target monocytes in neurological diseases, focusing on three key aspects of monocyte infiltration into the central nervous system, to provide new ideas for the treatment of neurodegenerative diseases.

关键词： blood–brain barrier macrophages monocytes multiple sclerosis neuroinflammation review therapy

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Influence of age and sex on pharmacodynamics of propofol in neurosurgical patients: model development

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Acta Pharmacologica Sinica 2006年第5期27卷 629-634页

作者： Yu-hong L1~(2,5) Fu-sheng WU~3 Jian-guo XU~4 ~2department of anesthesiology,~3department of Surgical Oncology,First Affiliated Hospital,Zhejiang University College of Medicine,Hangzhou 310003,China ~4department of anesthesiology,Nanjing Jinling Hospital,Nanjing 210002,China department of anesthesiology First Affiliated Hospital Zhejiang University College of Medicine Hangzhou China department of Surgical Oncology First Affiliated Hospital Zhejiang University College of Medicine Hangzhou China department of anesthesiology Nanjing Jinling Hospital Nanjing China

Aim:To determine propofol concentration in the cerebral spinal fluid （CSF） ofneurosurgical patients and carry out a preliminary population pharmacodynamicstudy.Methods:Twenty-seven elective neurosurgical patients （12 men and 15women） aged 17-74 years received propofol in a bolus dose of 2 mg/kg for 5 minand an infusion of 10 mg/kg per h for 5 min.Frequent CSF samples were drawn andassayed for propofol concentration.The bispectral index （BIS） was used to mea-sure the drug effect.All data were analyzed first with the Excel software package,then pharmacodynamics modeling was performed using the NONMEM softwarepackage.Results:The CSF concentration was related to the drug effect withlinear and sigmoid Emaxmodels.The parameters for the linear addictive modelwere a= 1.11 and b=95.4.The parameters for the linear exponential model were a=1.05 and b=92.7.The parameters for the sigmoid Emaxmodel were Emax=119,EC50=53.6ng/mL,and N=1.51.When the covariates of age,weight and sex wereconsidered,the parameters of models,objective function,the standard error of themean and the prediction error were not optimized.Conclusion:Linear additive,linear exponential and sigmoid Emaxmodels can be used to describe the pharmaco-dynamics of propofol with respect to the concentration in CSF.In this smallpopulation,age （17-74 years）,weight （47-98kg） and sex did not influence any ofthe pharmacodynamic parameters of propofol.To verify these preliminary results,a larger study population is required.

关键词： propofol cerebrospinal fluid age factors sex factors pharmcodynamics

Antioxidative effect of propofol during cardiopulmonary bypass in adults

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Acta Pharmacologica Sinica 2004年第3期25卷 80-86页

作者： Shi-hai ZHANG2,Shou-yong WANG,Shang-long YAO department of anesthesiology,Union Hospital,Tongji MedicalCollege,Huazhong Universityof Science & Technology,Wuhan 430022,China department of anesthesiology Union Hospital Tongji Medical College Huazhong University of Science & Technology Wuhan 430022

AIM: To investigate the antioxidative potential of propofol (an intravenous anesthetic with a chemical structure similarto phenol-basedfree radicalscavengers suchas vitaminE) during cardiopulmonary bypass(CPB). METHODS: Thirty adult patients referred for elective cardiac procedure with CPB were included and randomly allocated to a propofol group or a control group. Patients in the propofol group received propofol (0.1 mg·kg-1·min-1) intrave- nously for anesthesia maintenance, whereas those allocated to the control group received fentanyl 10 μg/kg intrave- nously and inhaled enflurane (1 %-1.5 %). Blood samples were collected at 7 time points: before the start of CPB, at 30 and 60 min of CPB, at the conclusion of CPB, 10 min after the administration of protamine, and 12 and 24 h after the cessation of CPB. Plasma levels of free F2-isoprostanes (sensitive markers of free radicals production) and complement C5a were determined by mass-spectrometricassay and enzyme immunoassay, respectively. Neu- trophil adhesion to endothelial cells was observed at ×200 magnificationunder a light microscope. RESULTS: Levels of F2-isoprostanes, complement C5a and neutrophil adhesion rate increased significantly during and after CPB in both groups. There were significantly higher levels of F2-isoprostanes, C5a, and more neutrophils adhering to endothelial cells in the control group than those in the propofol group, respectively. CONCLUSION: Cardio- pulmonary bypass is associated with a great production of damaging free radicals. Propofol may be beneficial both as an anesthetic and as a potent free radical scavenger in patients presenting pathologies associated with free radical reactions during CPB.

关键词： propofol cardiopulmonary bypass free radicals F2-isoprostanes complement 5a

Lactate:a prospective target for therapeutic intervention in psychiatric disease

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Neural Regeneration Research 2024年第7期19卷 1473-1479页

作者： Yanhui Cai Haiyun Guo Tianle Han Huaning Wang department of Psychiatry Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina department of anesthesiology and Perioperative Medicine Xijing HospitalFourth Military Medical UniversityXi’anShaanxi ProvinceChina

Although antipsychotics that act via monoaminergic neurotransmitter modulation have considera ble therapeutic effect,they cannot completely relieve clinical symptoms in patients suffering from psychiatric disorde rs.This may be attributed to the limited range of neurotransmitters that are regulated by psychotropic drugs.Recent findings indicate the need for investigation of psychotropic medications that target less-studied neurotransmitte rs.Among these candidate neurotransmitters,lactate is developing from being a waste metabolite to a glial-neuronal signaling molecule in recent years.Previous studies have suggested that cerebral lactate levels change considerably in numerous psychiatric illnesses;animal experiments have also shown that the supply of exogenous la ctate exerts an antidepressant effect.In this review,we have described how medications targeting newer neurotransmitte rs offer promise in psychiatric diseases;we have also summarized the advances in the use of lactate(and its corresponding signaling pathways)as a signaling molecule.In addition,we have described the alterations in brain lactate levels in depression,anxiety,bipolar disorder,and schizophrenia and have indicated the challenges that need to be overcome before brain lactate can be used as a therapeutic target in psychopharmacology.

关键词： antidepressant anxiety bipolar disorder depression lactate psychiatric disease psychopharmacology schizophrenia signal molecular therapeutics

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General anesthetic agents induce neurotoxicity through oligodendrocytes in the developing brain

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Zoological Research 2024年第3期45卷 691-703页

作者： Wen-Xin Hang Yan-Chang Yang Yu-Han Hu Fu-Quan Fang Lang Wang Xing-Hua Qian Patrick M.McQuillan Hui Xiong Jian-Hang Leng Zhi-Yong Hu department of anesthesiology First Affiliated HospitalZhejiang University School of MedicineHangzhouZhejiang 310003China department of Cell Biology Yale UniversityNew HavenCT 06520USA department of Neurology of the First Affiliated Hospital Interdisciplinary Institute of Neuroscience and TechnologySchool of Brain Science and Brain MedicineZhejiang University School of MedicineHangzhouZhejiang 310027China department of anesthesiology Jiaxing Maternity and Childcare Health HospitalJiaxingZhejiang 314009China department of anesthesiology Penn State Hershey Medical CentrePenn State College of MedicineHersheyPA 17033USA department of Central Laboratory Affiliated Hangzhou First People’s HospitalWestlake University School of MedicineHangzhouZhejiang 310006China

General anesthetic agents can impact brain function through interactions with neurons and their effects on glial cells.Oligodendrocytes perform essential roles in the central nervous system,including myelin sheath formation,axonal metabolism,and neuroplasticity regulation.They are particularly vulnerable to the effects of general anesthetic agents resulting in impaired proliferation,differentiation,and apoptosis.Neurologists are increasingly interested in the effects of general anesthetic agents on oligodendrocytes.These agents not only act on the surface receptors of oligodendrocytes to elicit neuroinflammation through modulation of signaling pathways,but also disrupt metabolic processes and alter the expression of genes involved in oligodendrocyte development and function.In this review,we summarize the effects of general anesthetic agents on oligodendrocytes.We anticipate that future research will continue to explore these effects and develop strategies to decrease the incidence of adverse reactions associated with the use of general anesthetic agents.

关键词： Oligodendrocytes General anesthetic agents Neurotoxicity Central nervous system Perioperative neurocognitive disorders