Respiratory Synkinesis seen in the biceps brachii muscle resulting from meningitis 20 years prior

No abstract available

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Endovascular thrombectomy in acute ischemic stroke: new treatment guide

Purpose of review Recent randomized clinical trials (RCTs) have demonstrated strong efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions (LVO). SIESTA, AnSTROKE, GOLIATH showed no deleterious effects of general anesthesia on patient outcome after EVT compared with conscious sedation. DAWN and DEFUSE 3 are extending the time window for EVT up to 24 h in carefully selected patients. This review discusses the current literature on the rapidly expanding subject of endovascular stroke therapy and optimal anesthetic management. Recent findings Recent retrospective studies of RCT data sets show that general anesthesia is associated with negative clinical outcome in AIS patients undergoing EVT when compared with sedation. Two of the possible mechanisms of this finding are systolic hypotension and hypocapnia. SIESTA, AnSTROKE, GOLIATH showed no difference in short-term clinical outcome between EVT patients treated with general anesthesia versus conscious sedation. DAWN and DEFUSE 3 demonstrated improved functional outcomes after EVT in those treated up to 24 h after selection with perfusion imaging, increasing the number of patients eligible for EVT. Summary Effective reperfusion with stent retriever technology, careful patient selection using perfusion imaging, and careful use of anesthetic technique affect outcome. Correspondence to Apolonia E. Abramowicz, MD, Department of Anesthesiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion Room 2391, Valhalla, NY 10595, USA. Tel: +1 914 493 7692; e-mail: elisabeth.abramowicz@gmail.com Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Emerging evidence for antidepressant actions of anesthetic agents

Purpose of review After decades without substantial advances, multiple novel antidepressants show promise against treatment-resistant depression. Interestingly, many of these are anesthetics. The purpose of this review is to discuss the evidence for the antidepressant effects of ketamine, nitrous oxide, isoflurane and propofol and to consider potential clinical, administrative and research implications for anesthesiologists. Recent findings Ketamine has acute, transient antidepressant and antisuicidal effects. Nitrous oxide has also shown antidepressant efficacy. There are converging preclinical and clinical data that isoflurane (and perhaps propofol), dosed to burst suppression, has relatively rapid, robust and durable antidepressant effects and lacks the adverse effects associated with electroconvulsive therapy (ECT). Summary Several anesthetics show promise as novel antidepressants. Ketamine is the most well studied. Anesthetic-induced burst-suppression may provide an alternative to ECT that lacks adverse cognitive effects. Further study is necessary to better understand how these drugs work and how they might be used as effective antidepressant therapy. Correspondence to Scott C. Tadler, Associate Professor, Department of Anesthesiology, Adjunct Associate Professor, Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT 84132, USA. Tel: +801 581 6393; e-mail: scott.tadler@hsc.utah.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Advances in pharmacokinetic modeling: target controlled infusions in the obese

Purpose of review The use of conventional pharmacokinetic parameters sets 'models' derived from nonobese patients has proven inadequate to administer intravenous anesthetics in the obese population and is commonly associated with higher than anticipated plasma propofol concentrations when used with target (plasma or effect site) controlled infusion pumps. In this review we will describe recent modeling strategies to characterize the disposition of intravenous anesthetics in the obese patient and will show clinically relevant aspects of new model's performance in the obese population. Recent findings Because clearance of a drug increases in a nonlinear manner with weight, nonlinear relationships better scale infusion rates between lean and obese individuals. Allometric concepts have been successfully used to describe size-related nonlinear changes in clearances. Other nonlinear scaling options include the use of descriptors such as body surface area, lean body weight, fat-free mass, and normal fat mass. Newer pharmacokinetic models, determined from obese patient data, have been developed for propofol and remifentanil using allometric concepts and comprehensive size descriptors. Summary Pharmacokinetic models to perform target-controlled infusion in the obese population should incorporate descriptors that reflect with greater precision the influence of body composition in volumes and clearances of each drug. It is our hope that commercially available pumps will soon incorporate these new models to improve the performance of this technique in the obese population. Correspondence to Luis I. Cortínez, Associate Professor, Pontificia Universidad Católica de Chile Santiago, Chile. Tel: +56(2)6382933; fax: +56(2)6327620; e-mail: licorti@med.puc.cl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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An overview of the cannabinoid type 2 receptor system and its therapeutic potential

Purpose of review This narrative review summarizes recent insights into the role of the cannabinoid type 2 (CB2) receptor as potential therapeutic target in neuropathic pain and neurodegenerative conditions. Recent findings The cannabinoid system continues to receive attention as a therapeutic target. The CB2 receptor is primarily expressed on glial cells only when there is active inflammation and appears to be devoid of undesired psychotropic effects or addiction liability. The CB2 receptor has been shown to have potential as a therapeutic target in models of diseases with limited or no currently approved therapies, such as neuropathic pain and neurodegenerative conditions such as Alzheimer's disease. Summary The functional involvement of CB2 receptor in neuropathic pain and other neuroinflammatory diseases highlights the potential therapeutic role of drugs acting at the CB2 receptor. Correspondence to Mohamed Naguib, MB, BCh, MSc, FCARCSI, MD, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave. - NE6–306, Cleveland, OH 44195, USA. Tel: +1 216 444 6328; fax: +1 216 636-2043; e-mail: naguibm@ccf.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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New horizons in anesthetic clinical pharmacology, patient outcomes and perioperative neuromonitoring

No abstract available

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Leveraging epigenomics and contactomics data to investigate SNP pairs in GWAS

Abstract

Although Genome Wide Association Studies (GWAS) have led to many valuable insights into the genetic bases of common diseases over the past decade, the issue of missing heritability has surfaced, as the discovered main effect genetic variants found to date do not account for much of a trait's predicted genetic component. We present a workflow, integrating epigenomics and topologically associating domain data, aimed at discovering trait-associated SNP pairs from GWAS where neither SNP achieved independent genome-wide significance. Each analyzed SNP pair consists of one SNP in a putative active enhancer and another SNP in a putative physically interacting gene promoter in a trait-relevant tissue. As a proof-of-principle case study, we used this approach to identify focused collections of SNP pairs that we analyzed in three independent Type 2 diabetes (T2D) GWAS. This approach led us to discover 35 significant SNP pairs, encompassing both novel signals and signals for which we have found orthogonal support from other sources. Nine of these pairs are consistent with eQTL results, two are consistent with our own capture C experiments, and seven involve signals supported by recent T2D literature.

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