Neural correlates of systemic lidocaine administration in healthy adults measured by functional MRI: a single arm open label study.

Introduction: Intravenous lidocaine is increasingly used as a nonopioid analgesic, but how it acts in the brain is incompletely understood. We conducted a functional MRI study of pain response, resting connectivity, and cognitive task performance in volunteers to elucidate the effects of lidocaine at the brain-systems level.

Methods: We enrolled 27 adults (age 22-55 yr) in this single-arm, open-label study.

Ipsilateral stimulation shows somatotopy of thumb and shoulder auricular points on the left primary somatosensory cortex using high-density fNIRS.

Significance: Auriculotherapy is a technique based on stimulation applied to specific ear points. Its mechanism of active and clinical efficacy remain to be established. This study aims to assess the role that primary somatosensory cortex may play to validate auriculotherapy mechanisms.

Psychometric and next day electrodermal activity data from an experiment involving midazolam, ketamine, and painful stimulation.

This is a report of unpublished data obtained from a randomized, single-blind, within-subject crossover design, neuroimaging trial comparing the effects of midazolam and ketamine on memory and pain. An experimental auditory paradigm paired with the periodic pain was used to examine auditory encoding and subsequent recognition. Psychometric surveys assessed stress, anxiety, depression, and pain behaviors.

Bispectral Index Changes Following Boluses of Commonly Used Intravenous Medications During Volatile Anesthesia Identified From Retrospective Data.

Background: Although patients are commonly monitored for depth of anesthesia, it is unclear to what extent administration of intravenous anesthetic medications may affect calculated bispectral (BIS) index values under general anesthesia.

Methods: In a retrospective analysis of electronic anesthesia records from an academic medical center, we examined BIS index changes associated with 14 different intravenous medications, as administered in routine practice, during volatile-based anesthesia using a novel screening approach. Discrete-time windows were identified in which only a single drug bolus was administered, and subsequent changes in the BIS index, concentration of volatile anesthetic, and arterial pressure were analyzed.

Brain connectivity under light sedation with midazolam and ketamine during task performance and the periodic experience of pain: Examining concordance between different approaches for seed-based connectivity analysis.

This work focused on functional connectivity changes under midazolam and ketamine sedation during performance of a memory task, with the periodic experience of pain. To maximize ability to compare to previous and future work, we performed secondary region of interest (ROI)-to-ROI functional connectivity analyses on these data, using two granularities of scale for ROIs. These findings are compared to the results of a previous seed-to-voxel analysis methodology, employed in the primary analysis.

Neutral auditory words immediately followed by painful electric shock may show reduced next-day recollection.

In this study, we investigated the effect of experimentally delivered acute pain on memory. Twenty-five participants participated in experimental sessions on consecutive days. The first session involved a categorization task to encourage memory encoding.

Anesthesia and the neurobiology of fear and posttraumatic stress disorder.

Purpose Of Review: Dysfunction of fear memory systems underlie a cluster of clinically important and highly prevalent psychological morbidities seen in perioperative and critical care patients, most archetypally posttraumatic stress disorder (PTSD). Several sedative-hypnotics and analgesics are known to modulate fear systems, and it is theoretically plausible that clinical decisions of the anesthesiologist could impact psychological outcomes. This review aims to provide a focused synthesis of relevant literature from multiple fields of research.

Early immersion in a dedicated one-month Anesthesiology Professional Practice rotation for Post-Graduate Year-1 interns is associated with an increase in scholarly activity during residency.

Study Objective: Despite the Accreditation Council for Graduate Medical Education scholarly activity requirement, incorporating education on scholarly fundamentals into residency is challenging. We designed and implemented an academic non-clinical rotation for Post Graduate Year-1 (PGY-1) interns and its association with subsequent resident scholarly productivity was determined. We hypothesized that early immersion in such a rotation would be associated with increased scholarly activity during residency.

Midazolam and Ketamine Produce Distinct Neural Changes in Memory, Pain, and Fear Networks during Pain.

Background: Despite the well-known clinical effects of midazolam and ketamine, including sedation and memory impairment, the neural mechanisms of these distinct drugs in humans are incompletely understood. The authors hypothesized that both drugs would decrease recollection memory, task-related brain activity, and long-range connectivity between components of the brain systems for memory encoding, pain processing, and fear learning.

Methods: In this randomized within-subject crossover study of 26 healthy adults, the authors used behavioral measures and functional magnetic resonance imaging to study these two anesthetics, at sedative doses, in an experimental memory paradigm using periodic pain.

Opportunities Beyond the Anesthesiology Department: Broader Impact Through Broader Thinking.

Ensuring a productive clinical and research workforce requires bringing together physicians and communities to improve health, by strategic targeting of initiatives with clear and significant public health relevance. Within anesthesiology, the traditional perspective of the field's health impact has focused on providing safe and effective intraoperative care, managing critical illness, and treating acute and chronic pain. However, there are limitations to such a framework for anesthesiology's public health impact, including the transient nature of acute care episodes such as the intraoperative period and critical illness, and a historical focus on analgesia alone-rather than the complex psychosocial milieu-for pain management.

Roadmap for Conducting Neuroscience Research in the COVID-19 Era and Beyond: Recommendations From the SNACC Research Committee.

The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of neuroscience research. At the 2020 Society of Neuroscience in Anesthesiology and Critical Care (SNACC) Annual Meeting, the SNACC Research Committee met virtually to discuss research challenges encountered during the COVID-19 pandemic along with possible strategies for facilitating research activities. These challenges and recommendations are included in this Consensus Statement.

Psychometric and electrodermal activity data from an experimental paradigm of memory encoding with some items periodically followed by painful electric shock.

How pain influences explicit memory is an active area of investigation, and next-day recognition was the primary outcome of this experiment. The data reported here were secondary measures of psychometrics to quantify interindividual variability between subjects and measure electrodermal activity (EDA) changes in response to experimental stimuli. Reliable EDA responses following painful electric shocks were obtained in the Learning portion of the experiment.

Wellness Principles Correlate With More Favorable Burnout Scores in Junior Anesthesiology Residents.

Background: Strategies to prevent or reduce burnout for anesthesiology residents remain relatively unexplored. We aimed to determine if participation in a wellness course would be associated with lower burnout.

Methods: A prospective, case-control survey/questionnaire study was implemented within a single anesthesiology residency in a large academic medical center program.

Retrospective analysis of cases of intraoperative awareness in a large multi-hospital health system reported in the early postoperative period.

Background: Awareness with recall under general anesthesia remains a rare but important issue that warrants further study.

Methods: We present a series of seven cases of awareness that were identified from provider-reported adverse event data from the electronic anesthesia records of 647,000 general anesthetics.

Results: The low number of identified cases suggests an under-reporting bias.

Financial Incentive, in Place of Nonclinical Time, Increases Faculty Involvement and Improves Resident Didactic Evaluation Scores in an Anesthesiology Residency Training Program.

Background: Providing clinical faculty to lead high-quality resident didactic sessions remains a challenge for academic departments that host graduate medical education training programs. In an effort to both reduce costs and to continue to recruit faculty to give lectures, our department began to incentivize clinicians with a $500 stipend in place of a nonclinical day to present didactics. Our hypothesis is that with financial incentive, more attendings would present didactics and the quality would improve.

Memory for non-painful auditory items is influenced by whether they are experienced in a context involving painful electrical stimulation.

In this study, we sought to examine the effect of experimentally induced somatic pain on memory. Subjects heard a series of words and made categorization decisions in two different conditions. One condition included painful shocks administered just after presentation of some of the words; the other condition involved no shocks.

The triple variable index combines information generated over time from common monitoring variables to identify patients expressing distinct patterns of intraoperative physiology.

Background: Mean arterial pressure (MAP), bispectral index (BIS), and minimum alveolar concentration (MAC) represent valuable, yet dynamic intraoperative monitoring variables. They provide information related to poor outcomes when considered together, however their collective behavior across time has not been characterized.

Methods: We have developed the Triple Variable Index (TVI), a composite variable representing the sum of z-scores from MAP, BIS, and MAC values that occur together during surgery.

Cortical Networks Involved in Memory for Temporal Order.

We examined the neurobiological basis of temporal resetting, an aspect of temporal order memory, using a version of the delayed-match-to-multiple-sample task. While in an fMRI scanner, participants evaluated whether an item was novel or whether it had appeared before or after a reset event that signified the start of a new block of trials. Participants responded "old" to items that were repeated within the current block and "new" to both novel items and items that had last appeared before the reset event (pseudonew items).

Human Posterior Insula Functional Connectivity Differs Between Electrical Pain and the Resting State.

The objective in this study was to directly compare MRI-based functional connectivity between conditions of rest and painful electrical nerve stimulation for key regions involved in pain processing: the anterior and posterior insula and the anterior cingulate cortex. Electric nerve stimulation, rated 7/10 for pain, was delivered to the right index finger of 14 healthy pain-free adult volunteers in four 30-sec blocks and continuously for 2 min. Functional connectivity maps obtained at rest and during both pain tasks were compared using seed time courses from the left anterior and posterior insula and anterior cingulate.

Optimizing and Interpreting Insular Functional Connectivity Maps Obtained During Acute Experimental Pain: The Effects of Global Signal and Task Paradigm Regression.

The insula is uniquely located between the temporal and parietal cortices, making it anatomically well-positioned to act as an integrating center between the sensory and affective domains for the processing of painful stimulation. This can be studied through resting-state functional connectivity (fcMRI) imaging; however, the lack of a clear methodology for the analysis of fcMRI complicates the interpretation of these data during acute pain. Detected connectivity changes may reflect actual alterations in low-frequency synchronous neuronal activity related to pain, may be due to changes in global cerebral blood flow or the superimposed task-induced neuronal activity.

Pain does not follow the boxcar model: temporal dynamics of the BOLD fMRI signal during constant current painful electric nerve stimulation.

Unlabelled: The temporal dynamics of the blood oxygen level-dependent (BOLD) signal, especially for painful stimulations, is not completely understood. In this study, the BOLD signal response to a long painful electrical stimulation (a continuous painful stimulation of 2 minutes) is directly compared to that of a short painful stimulation (four 30-second periods of painful stimulation interleaved with 30-second rest) in an effort to further probe the relationship between the temporal dynamics of the BOLD signal during constant-intensity pain stimulation. Time course analysis showed that both stimulation protocols produced 3 similarly timed peaks in both data sets, suggesting an early and delayed BOLD response to painful stimulation initiation, and a response related to stimulus termination.

Comparison between end-tidal CO₂ and respiration volume per time for detecting BOLD signal fluctuations during paced hyperventilation.

Respiratory motion and capnometry monitoring were performed during blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) of the brain while a series of paced hyperventilation tasks were performed that caused significant hypocapnia. Respiration volume per time (RVT) and end-tidal carbon dioxide (ETCO(2)) were determined and compared for their ability to explain BOLD contrast changes in the data. A 35% decrease in ETCO(2) was observed along with corresponding changes in RVT.

The impact of physiologic noise correction applied to functional MRI of pain at 1.5 and 3.0 T.

This study quantified the impact of the well-known physiologic noise correction algorithm RETROICOR applied to a pain functional magnetic resonance imaging (FMRI) experiment at two field strengths: 1.5 and 3.0 T.

Fluoroscopic angiography in the gross anatomy dissection laboratory: visualizing the aortic arch and its branches in a cadaver.

We present fluoroscopic images of the aortic arch and its branches obtained in a first year medical gross anatomy teaching laboratory after an aberrant right subclavian artery was discovered during dissection. The aortic arch and its branches in the cadaver were filled with contrast medium in molten agar. After the agar solidified, a portable fluoroscope was used to obtain radiographic images.

Doxycycline-regulated gene expression in the opportunistic fungal pathogen Aspergillus fumigatus.

Background: Although Aspergillus fumigatus is an important human fungal pathogen there are few expression systems available to study the contribution of specific genes to the growth and virulence of this opportunistic mould. Regulatable promoter systems based upon prokaryotic regulatory elements in the E. coli tetracycline-resistance operon have been successfully used to manipulate gene expression in several organisms, including mice, flies, plants, and yeast.