Immediate effects of propofol on mood: a randomized comparison of two doses in a cohort with depression.

Rationale: The intravenous anesthetic propofol is known to induce positive mood effects during routine clinical use, suggesting it might be repurposed as an antidepressant, but also raising concerns about abuse potential. How propofol's acute effects vary by dose and with repeated infusions is unknown.

Objectives: This exploratory analysis aimed to (1) compare the immediate mood effects of propofol administered at two different doses, (2) describe how those mood effects change with repeated infusions, and (3) evaluate whether acute mood improvement predicts later antidepressant response.

Near-infrared spectroscopy for kidney oxygen monitoring in a porcine model of hemorrhagic shock, hemodilution, and REBOA.

Acute kidney injury is a common complication of trauma and hemorrhagic shock. In a porcine model of hemorrhagic shock, resuscitative endovascular balloon aortic occlusion (REBOA) and hemodilution, we hypothesized that invasive kidney oxygen concentration measurements would correlate more strongly with noninvasive near infra-red spectroscopy (NIRS) oxygen saturation measurements when cutaneous sensors were placed over the kidney under ultrasound guidance compared to placement over the thigh muscle and subcutaneous tissue. Eight anesthetized swine underwent hemorrhagic shock 4 of which were resuscitated with intravenous fluids prior to the return of shed blood (Hemodilution protocol) and 4 of which underwent REBOA prior to resuscitation and return of shed blood (REBOA protocol).

Anesthesia Patient Monitoring 2050.

The monitoring of vital signs in patients undergoing anesthesia began with the very first case of anesthesia and has evolved alongside the development of anesthesiology ever since. Patient monitoring started out as a manually performed, intermittent, and qualitative assessment of the patient's general well-being in the operating room. In its evolution, patient monitoring development has responded to the clinical need, for example, when critical incident studies in the 1980s found that many anesthesia adverse events could be prevented by improved monitoring, especially respiratory monitoring.

Propofol for treatment resistant depression: A randomized controlled trial.

Background: Anesthetic agents including ketamine and nitrous oxide have shown antidepressant properties when appropriately dosed. Our recent open-label trial of propofol, an intravenous anesthetic known to elicit transient positive mood effects, suggested that it may also produce robust and durable antidepressant effects when administered at a high dose that elicits an electroencephalographic (EEG) burst-suppression state. Here we report findings from a randomized controlled trial ( NCT03684447 ) that compared two doses of propofol.

Combining Machine Learning and Urine Oximetry: Towards an Intraoperative AKI Risk Prediction Algorithm.

Acute kidney injury (AKI) affects up to 50% of cardiac surgery patients. The definition of AKI is based on changes in serum creatinine relative to a baseline measurement or a decrease in urine output. These monitoring methods lead to a delayed diagnosis.

Intraoperative Urine Oxygen in Cardiac Surgery and 12-Month Outcomes.

Low intraoperative urinary oxygen during cardiac surgery is associated with increased risk of poor 12-month outcomes. With decreasing urinary oxygen thresholds, the risk of poor 12-month outcomes increases.

Prolonged Opioid Use and Pain Outcome and Associated Factors after Surgery under General Anesthesia: A Prospective Cohort Association Multicenter Study.

Background: There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery.

Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock.

Up to 50% of patients with trauma develop acute kidney injury (AKI), in part due to poor renal perfusion after severe blood loss. AKI is currently diagnosed based on a change in serum creatinine concentration from baseline or prolonged periods of decreased urine output. Unfortunately, baseline serum creatinine concentration data is unavailable in most patients with trauma, and current estimation methods are inaccurate.

The impact of urine flow on urine oxygen partial pressure monitoring during cardiac surgery.

Purpose: Urine oxygen partial pressure (PuO) may be useful for assessing acute kidney injury (AKI) risk. The primary purpose of this study was to quantify the ability of a novel urinary oxygen monitoring system to make real-time PuO measurements intraoperatively which depends on adequate urine flow. We hypothesized that PuO data could be acquired with enough temporal resolution to provide real-time information in both AKI and non-AKI patients.

Analysis of skew of visible laser reflections in a living sheep heart.

Limited methods exist to confirm the position of cardiovascular devices in the heart. In our earlier work, an optical fiber was enclosed in a central catheter and guided to known positions in the superior vena cava and right atrium in the heart of a living sheep. The tissues were illuminated with two wavelengths of visible light and the reflections were analyzed using frequency domain techniques.

Catheter-mounted smart hydrogel ultrasound resonators for intravenous analyte monitoring.

Continuous monitoring of drug concentrations in blood plasma can be beneficial to guide individualized drug administration. High interpatient variability in required dosage and a small therapeutic window of certain drugs, such as anesthetic medications, can cause risks and challenges in accurate dosing during administration. In this work, we present a sensing platform concept using a smart hydrogel micro resonator sheet with medical ultrasound readout that is integrated on the top of a catheter.

Noninvasive Urine Oxygen Monitoring and the Risk of Acute Kidney Injury in Cardiac Surgery.

Background: Acute kidney injury (AKI) is a common complication of cardiac surgery. An intraoperative monitor of kidney perfusion is needed to identify patients at risk for AKI. The authors created a noninvasive urinary oximeter that provides continuous measurements of urinary oxygen partial pressure and instantaneous urine flow.

Practice Patterns and Variability in Intraoperative Opioid Utilization: A Report From the Multicenter Perioperative Outcomes Group.

Background: Opioids remain the primary mode of analgesia intraoperatively. There are limited data on how patient, procedural, and institutional characteristics influence intraoperative opioid administration. The aim of this retrospective, longitudinal study from 2012 to 2016 was to assess how intraoperative opioid dosing varies by patient and clinical care factors and across multiple institutions over time.

Joint time-frequency analysis of visible laser reflections in a sheep heart.

Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber-based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser-based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction.

Volatile anesthetic gas concentration sensing using flow sensor fusion for use in Austere settings.

Flow sensors are often sensitive to the presence of volatile anesthetics. However, this sensitivity provides a unique opportunity to combine flow sensors of differing technological principles as an alternative to measuring volatile anesthetic gas concentration, particularly for austere settings. To determine the feasibility of flow sensor fusion for volatile anesthetic concentrations monitoring, eight flow sensors were tested with isoflurane, sevoflurane, and desflurane, ranging in concentrations from 0-4.

Intraoperative Urinary Biomarkers and Acute Kidney Injury After Cardiac Surgery.

Objectives: To evaluate the association of intraoperative urinary biomarker excretion during cardiac surgery and the subsequent development of acute kidney injury (AKI).

Design: Prospective, nonrandomized, observational study.

Setting: Single tertiary-level, university-affiliated hospital.

Technologies to Optimize the Care of Severe COVID-19 Patients for Health Care Providers Challenged by Limited Resources.

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks.

Multicenter Perioperative Outcomes Group Enhanced Observation Study Postoperative Pain Profiles, Analgesic Use, and Transition to Chronic Pain and Excessive and Prolonged Opioid Use Patterns Methodology.

To study the impact of anesthesia opioid-related outcomes and acute and chronic postsurgical pain, we organized a multicenter study that comprehensively combined detailed perioperative data elements from multiple institutions. By combining pre- and postoperative patient-reported outcomes with automatically extracted high-resolution intraoperative data obtained through the Multicenter Perioperative Outcomes Group (MPOG), the authors sought to describe the impact of patient characteristics, preoperative psychological factors, surgical procedure, anesthetic course, postoperative pain management, and postdischarge pain management on postdischarge pain profiles and opioid consumption patterns. This study is unique in that it utilized multicenter prospective data collection using a digital case report form integrated with the MPOG framework and database.

A comparison of ventilation with a non-invasive ventilator versus standard O with a nasal cannula for colonoscopy with moderate sedation using propofol.

The aim of this study was to test the effects of CPAP on moderately sedated patients undergoing colonoscopy. Our hypothesis was that CPAP can reduce the incidence and duration of obstructive apnea and hemoglobin oxygen desaturation in patients undergoing procedural sedation for colonoscopy. Two groups of consenting adult patients scheduled to undergo routine colonoscopy procedures and sedated with propofol and fentanyl were monitored in this study: control and intervention.

A comparison of controlled ventilation with a noninvasive ventilator versus traditional mask ventilation.

After induction, but before intubation, many general anesthesia patients are manually bag-mask ventilated. The objective of this study was to determine the efficacy of bag-mask ventilation (MkV) of an anesthetized patient versus mask ventilation using a noninvasive ventilator (NIV). We hypothesized that feedback-controlled, mask ventilation via NIV is more efficacious and safer.