Daily Anesthesiology Research Analysis

BACKGROUND: Repeated early-life exposure to general anesthetics might affect social behavior. Perineuronal nets (PNNs), which enwrap around parvalbumin (PV) interneurons and support their function, are crucial for social memory. Given that microglia contribute to PNN remodeling and are responsive to anesthetic exposure, we hypothesized that repeated neonatal sevoflurane exposure impairs social memory via microglia-mediated PNN degradation. METHODS: Mice were exposed to 2.5 % sevoflurane for 2 h daily during postnatal days 7-9. At postnatal day 28, we evaluated social behavior, PNN integrity, patch-clamp recordings, and conducted analyses of microglia and PV interneurons. Subsequently, we explored the effects of microglia depletion by PLX5622 (CSF1R antagonist) and repopulation on social behavior and PNNs after repeated sevoflurane exposure. RESULTS: We found that repeated neonatal sevoflurane exposure led to social memory deficit in male mice. This deficit coincided with significant PNN loss in the prefrontal cortex, increased excitability of PV interneurons, and enhanced inhibitory input to pyramidal neurons. Microglia exhibited elevated phagocytic activity toward PNNs after repeated neonatal sevoflurane exposure. Notably, microglial depletion and repopulation rescued PNN integrity and social memory performance. CONCLUSIONS: Our findings reveal microglia-dependent PNN degradation as a key mechanism underlying early-life sevoflurane exposure-induced social memory impairments in male mice. Targeting microglial activity or preserving PNNs may offer new strategies to prevent anesthesia-induced neurodevelopmental impairments.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an important intraoperative support strategy in lung transplantation, particularly for high-risk patients. Although ECMO offers theoretical advantages such as controlled reperfusion and hemodynamic stabilization, its impact on postoperative outcomes compared with off-pump techniques remains debated. This study aimed to evaluate evidence comparing ECMO and off-pump approaches. METHODS: Three databases were assessed. The primary outcome was overall survival. Secondary outcomes included time until extubation, intensive care unit and hospital length of stay (LOS), primary graft dysfunction at postoperative day 3, and need for renal replacement therapy. Hazard ratio, odds ratio, and mean difference (MD) with 95% confidence interval (CI) were calculated. Time-to-event data reconstruction and sensitivity analyses were performed. A subgroup analysis compared planned versus unplanned ECMO to address treatment allocation bias. RESULTS: Six retrospective studies with 1008 patients were included. ECMO was associated with lower overall survival (hazard ratio, 1.555; 95% CI, 1.13-2.15; P = 0.007). ECMO also resulted in longer time until extubation (MD, 1.24 d; 95% CI, 0.38-2.09; P = 0.005), intensive care unit LOS (MD, 2.40 d; 95% CI, 1.20-3.61; P < 0.001), hospital LOS (MD, 3.61 d; 95% CI, 0.81-6.40; P = 0.011), and higher primary graft dysfunction incidence at day 3 (odds ratio, 2.18; 95% CI, 1.34-3.53; P = 0.002). No significant difference was observed for renal replacement therapy (P = 0.054). Landmark analysis showed poorer survival for patients supported with ECMO during the first 6 mo but not beyond. CONCLUSIONS: ECMO is associated with poorer early survival and adverse outcomes but remains crucial for high-risk patients, underscoring the need for optimized selection and standardized management.

BACKGROUND: In Japan, labor neuraxial analgesia (LNA) is frequently administered by obstetricians rather than board-certified anesthesiologists, particularly in smaller facilities. Although awareness of maternal safety has increased in recent years, the extent of anesthesiologist involvement in obstetric anesthesia remains unclear. METHODS: This nationwide cross-sectional study analyzed data from Birth-Navi, a public registry of childbirth facilities maintained by Ministry of Health, Labour and Welfare of Japan. As of August 2024, facilities offering LNA were categorized into two groups: those listing a board-certified anesthesiologist (Group A) and an obstetrician-gynecologist (Group O) as a responsible physician. Institutional characteristics and analgesia practices were compared between groups using chi-square tests. RESULTS: Among 2063 registered facilities, 837 (40.6%) provided LNA, of which 771 met the inclusion criteria. Only 27.2% facilities listed a board-certified anesthesiologist as the responsible physician. Group A facilities were more likely to be hospitals (86.8% vs. 30.4%, p < 0.001) and more likely to utilize combined spinal-epidural techniques (23.7% vs. 14.0%, p = 0.002). However, 24 h analgesia availability was significantly lower in Group A than in Group O (25.9% vs. 47.1%, p < 0.05). Notably, only 284 facilities (13.8%) provided round-the-clock analgesia upon maternal request. CONCLUSION: It is important to note that anesthesiologist-led LNA remains limited in Japan. While associated with more advanced techniques, 24 h availability is uncommon. To improve both access and safety, system-level strategies-such as redistribution of personnel and the implementation of collaborative tele-anesthesia networks-should be considered.