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Article ; Online: Perioperative Considerations for Patients Exposed to Psychostimulants.

Emerick, Trent D / Martin, Thomas J / Ririe, Douglas G

2023 Volume 137, Issue 3, Page(s) 474–487

Abstract: Concerns regarding the perioperative management of acute psychostimulant intoxication have been recognized for decades, but novel and diverse substances in this class continue to be developed. Despite the similarities in mechanisms of action among ... ...

Abstract	Concerns regarding the perioperative management of acute psychostimulant intoxication have been recognized for decades, but novel and diverse substances in this class continue to be developed. Despite the similarities in mechanisms of action among psychostimulants, each subclass within this broad category has unique receptor specificity and different mechanisms that play a role in patient clinical presentation. These issues present challenges to anesthesia providers when caring for patients with either acute or chronic exposure to psychostimulants during the perioperative period. Challenges result from both physiological and psychological effects that influence the action of the primary anesthetic agent, adjuvant anesthetics, and analgesics used for perioperative management of pain. The epidemiology, pharmacology, and perioperative implications of psychostimulant use are presented for amphetamines and similar acting nonamphetamines, cocaine, and, finally, the mixed-action drugs known as entactogens that share stimulant and psychedelic properties. This information is then used as the foundation for safe and effective perioperative management of patients exposed to psychostimulants.
MeSH term(s)	Humans ; Central Nervous System Stimulants/adverse effects ; Cocaine ; Anesthesia/adverse effects ; Pain ; Patients
Chemical Substances	Central Nervous System Stimulants ; Cocaine (I5Y540LHVR)
Language	English
Publishing date	2023-08-17
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006303
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Article: A Painful Beginning: Early Life Surgery Produces Long-Term Behavioral Disruption in the Rat.

Ririe, Douglas G / Eisenach, James C / Martin, Thomas J

Frontiers in behavioral neuroscience

2021 Volume 15, Page(s) 630889

Abstract: Early life surgery produces peripheral nociceptive activation, inflammation, and stress. Early life nociceptive input and inflammation have been shown to produce long-term processing changes that are not restricted to the dermatome of injury. ... ...

Abstract	Early life surgery produces peripheral nociceptive activation, inflammation, and stress. Early life nociceptive input and inflammation have been shown to produce long-term processing changes that are not restricted to the dermatome of injury. Additionally stress has shown long-term effects on anxiety, depression, learning, and maladaptive behaviors including substance abuse disorder and we hypothesized that early life surgery would have long-term effects on theses complex behaviors in later life. In this study surgery in the rat hindpaw was performed to determine if there are long-term effects on anxiety, depression, audiovisual attention, and opioid reward behaviors. Male animals received paw incision surgery and anesthesia or anesthesia alone (sham) at postnatal day 6. At 10 weeks after surgery, open field center zone entries were decreased, a measure of anxiety (
Language	English
Publishing date	2021-05-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2452960-6
ISSN	1662-5153
ISSN	1662-5153
DOI	10.3389/fnbeh.2021.630889
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Article ; Online: How long does incisional pain last: early life vulnerability could make it last a lifetime.

Ririe, Douglas G

Anesthesiology

2015 Volume 122, Issue 6, Page(s) 1189–1191

MeSH term(s)	Animals ; Female ; Foot Injuries/pathology ; Hyperalgesia/pathology ; Male ; Medulla Oblongata/injuries ; Medulla Oblongata/surgery ; Microglia/drug effects ; p38 Mitogen-Activated Protein Kinases/drug effects
Chemical Substances	p38 Mitogen-Activated Protein Kinases (EC 2.7.11.24)
Language	English
Publishing date	2015-06
Publishing country	United States
Document type	Comment ; Editorial ; Research Support, N.I.H., Extramural
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000000660
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Article ; Online: Effects of multiple anesthetic exposures on rhesus macaque brain development: a longitudinal structural MRI analysis.

Kim, Jeongchul / Barcus, Richard / Lipford, Megan E / Yuan, Hongyu / Ririe, Douglas G / Jung, Youngkyoo / Vlasova, Roza M / Styner, Martin / Nader, Michael A / Whitlow, Christopher T

Cerebral cortex (New York, N.Y. : 1991)

2023 Volume 34, Issue 1

Abstract: Concerns about the potential neurotoxic effects of anesthetics on developing brain exist. When making clinical decisions, the timing and dosage of anesthetic exposure are critical factors to consider due to their associated risks. In our study, we ... ...

Abstract	Concerns about the potential neurotoxic effects of anesthetics on developing brain exist. When making clinical decisions, the timing and dosage of anesthetic exposure are critical factors to consider due to their associated risks. In our study, we investigated the impact of repeated anesthetic exposures on the brain development trajectory of a cohort of rhesus monkeys (n = 26) over their first 2 yr of life, utilizing longitudinal magnetic resonance imaging data. We hypothesized that early or high-dose anesthesia exposure could negatively influence structural brain development. By employing the generalized additive mixed model, we traced the longitudinal trajectories of brain volume, cortical thickness, and white matter integrity. The interaction analysis revealed that age and cumulative anesthetic dose were variably linked to white matter integrity but not to morphometric measures. Early high-dose exposure was associated with increased mean, axial, and radial diffusivities across all white matter regions, compared to late-low-dose exposure. Our findings indicate that early or high-dose anesthesia exposure during infancy disrupts structural brain development in rhesus monkeys. Consequently, the timing of elective surgeries and procedures that require anesthesia for children and pregnant women should be strategically planned to account for the cumulative dose of volatile anesthetics, aiming to minimize the potential risks to brain development.
MeSH term(s)	Humans ; Animals ; Child ; Female ; Pregnancy ; Macaca mulatta ; Diffusion Tensor Imaging/methods ; Brain ; Magnetic Resonance Imaging ; White Matter/pathology ; Anesthetics/toxicity
Chemical Substances	Anesthetics
Language	English
Publishing date	2023-12-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1077450-6
ISSN	1460-2199 ; 1047-3211
ISSN (online)	1460-2199
ISSN	1047-3211
DOI	10.1093/cercor/bhad463
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Article ; Online: Post-discharge hyperpolarization is an endogenous modulatory factor limiting input from fast-conducting nociceptors (AHTMRs).

Boada, M Danilo / Ririe, Douglas G / Eisenach, James C

Molecular pain

2017 Volume 13, Page(s) 1744806917726255

Abstract: Peripheral somatosensory neurons are frequently exposed to mechanical forces. Strong stimuli result in neuronal activation of high-threshold mechanosensory afferent neurons, even in the absence of tissue damage. Among these neurons, fast-conducting ... ...

Abstract	Peripheral somatosensory neurons are frequently exposed to mechanical forces. Strong stimuli result in neuronal activation of high-threshold mechanosensory afferent neurons, even in the absence of tissue damage. Among these neurons, fast-conducting nociceptors (A-fiber high-threshold mechanoreceptors (AHTMRs)) are normally resistant to sustained activation, transiently encoding the mechanical stimulus intensity but not its full duration. This rapidly adapting response seems to depend on changes in the electrical excitability of the membrane of these afferent neurons during sustained stimulation, a restraint mechanism that disappears following sensitization. Here, we examine the mechanism by which strong peripheral activation of mechanoreceptors elicits this control process in the absence of tissue injury and temporally silences afferent neurons despite ongoing stimulation. To study this, mechanoreceptors in Sprague-Dawley rats were accessed at the soma in the dorsal root ganglia from T11 and L4/L5. Neuronal classification was performed using receptive field characteristics and passive and active electrical properties. Sustained mechanical nociceptive stimulation in the absence of tissue damage of AHTMRs induces a rapid membrane hyperpolarization and a period of reduced responsiveness to the stimuli. Moreover, this phenomenon appears to be unique to this subset of afferent neurons and is absent in slow-conducting C-mechanonociceptors (C-fiber high-threshold mechanoreceptors) and rapidly adapting fast-conducting low-threshold mechanoreceptors. Furthermore, this mechanism for rapid adaptation and reducing ongoing input is ablated by repeated strong stimuli and in sensitized AHTMRs after chronic neuropathic injury. Further studies to understand the underling molecular mechanisms behind this phenomenon and their modulation during the development of pathological conditions may provide new targets to control nociceptive hyperexcitability and chronic pain.
MeSH term(s)	Action Potentials/physiology ; Animals ; Female ; Ganglia, Spinal/metabolism ; Ligation ; Lumbar Vertebrae/pathology ; Lumbar Vertebrae/physiopathology ; Male ; Mechanoreceptors/metabolism ; Neural Conduction ; Neurons, Afferent/metabolism ; Nociceptors/metabolism ; Pain Threshold ; Rats, Sprague-Dawley ; Spinal Nerves/pathology ; Spinal Nerves/physiopathology ; Thoracic Vertebrae/pathology ; Thoracic Vertebrae/physiopathology
Language	English
Publishing date	2017-08-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2174252-2
ISSN	1744-8069 ; 1744-8069
ISSN (online)	1744-8069
ISSN	1744-8069
DOI	10.1177/1744806917726255
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Article ; Online: Nerve injury induced activation of fast-conducting high threshold mechanoreceptors predicts non-reflexive pain related behavior.

Boada, M Danilo / Martin, Thomas J / Ririe, Douglas G

Neuroscience letters

2016 Volume 632, Page(s) 44–49

Abstract: The role of specific subsets of peripheral nerves in pain related behavior remains unclear. To better understand the contribution of differential activation of fast-conducting, high-threshold mechanoreceptor (AHTMR) input, we hypothesized that neuronal ... ...

Abstract	The role of specific subsets of peripheral nerves in pain related behavior remains unclear. To better understand the contribution of differential activation of fast-conducting, high-threshold mechanoreceptor (AHTMR) input, we hypothesized that neuronal activation would be distinct with nerve injury, and that nociceptive input would predictt behavior in the freely exploring animal. A series of surfaces was used to deliver mechanical input to the hindpaws of rats upon voluntary movement and exploration. Neuronal activation increased as apex surface decreased (0.2, 0.6, 1.0 and 1.5mm) using in vivo recording in L4 DRG neurons, and this relationship was enhanced following partial ligation of L5 (pSNL). In behaving animals, apex size was correlated to time spent on each surface following pSNL, but not with sham. Morphine normalized the discriminatory behavior following pSNL. These data indicate that noxious mechanical activation of AHTMR upon normal movement predicts behavior using paradigms that do not rely on reflexive withdrawal responses suggesting that AHTMR activation and central nervous system input contribute to higher order pain behavior after nerve injury beyond the immediate early pain input long attributed to these neurons.
MeSH term(s)	Animals ; Behavior, Animal/physiology ; Hyperalgesia/etiology ; Hyperalgesia/physiopathology ; Male ; Mechanoreceptors/physiology ; Neural Conduction/physiology ; Pain Measurement ; Pain Threshold/physiology ; Peripheral Nerve Injuries/complications ; Peripheral Nerve Injuries/physiopathology ; Physical Stimulation ; Rats ; Rats, Sprague-Dawley ; Spinal Nerves/injuries
Language	English
Publishing date	2016-10-06
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	194929-9
ISSN	1872-7972 ; 0304-3940
ISSN (online)	1872-7972
ISSN	0304-3940
DOI	10.1016/j.neulet.2016.08.029
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Article ; Online: An inconvenient truth: Supraglottic devices can lead to potentially significant increases in the apparatus dead space in the anesthetized infant.

Templeton, T Wesley / Goenaga-Díaz, Eduardo J / Templeton, Leah B / Ririe, Douglas G

Paediatric anaesthesia

2018 Volume 28, Issue 7, Page(s) 672–673

MeSH term(s)	Humans ; Infant ; Intubation, Intratracheal ; Tidal Volume
Language	English
Publishing date	2018-08-20
Publishing country	France
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13407
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Article ; Online: Risk factors for administration of additional reversal following neuromuscular blockade with rocuronium in children: A retrospective case-control study.

Vishneski, Susan R / Saha, Amit K / Fram, Madeline R / Templeton, Leah B / Lee, Lisa K / Ririe, Douglas G / Goenaga-Diaz, Eduardo Javier / Smith, Laura Daniela / Templeton, Thomas Wesley

Paediatric anaesthesia

2022 Volume 32, Issue 8, Page(s) 916–925

Abstract: Background: The prevalence and risk factors for residual neuromuscular blockade in children remain poorly characterized. We hypothesize that specific patient and anesthetic risk factors may be associated with the administration of additional reversal in ...

Abstract	Background: The prevalence and risk factors for residual neuromuscular blockade in children remain poorly characterized. We hypothesize that specific patient and anesthetic risk factors may be associated with the administration of additional reversal in children following initial reversal of rocuronium with neostigmine. Methods: Our electronic health record was queried for patients <18 years of age who received rocuronium and reversal with neostigmine from 2017 through 2020. Patients receiving other nondepolarizing neuromuscular blocking drugs were excluded. The outcome of interest was defined as the administration of additional neostigmine or sugammadex following primary reversal with neostigmine. Time between the last dose of rocuronium and initial dose of neostigmine, and the cumulative dose of rocuronium were dichotomized. These were combined with other covariates including age, weight, sex, racial group, procedure type, ASA physical status, >1 rocuronium dose administered during the procedure, initial neostigmine dose <0.05 mg kg Results: During the study period, 101/6373 (1.58%) patients received rocuronium and additional reversal. Dichotomization of time between last dose of rocuronium and neostigmine yielded <28 min since the last dose of rocuronium and cumulative dose of rocuronium >0.45 mg kg Conclusion: Risk factors associated with the administration of additional reversal included time <28 min from the last dose of rocuronium to initial dose of neostigmine, cumulative dose of rocuronium >0.45 mg kg
MeSH term(s)	Androstanols ; Anesthetics ; Case-Control Studies ; Child ; Humans ; Neostigmine/pharmacology ; Neuromuscular Blockade/adverse effects ; Neuromuscular Blockade/methods ; Neuromuscular Diseases ; Neuromuscular Nondepolarizing Agents ; Retrospective Studies ; Risk Factors ; Rocuronium ; gamma-Cyclodextrins/adverse effects
Chemical Substances	Androstanols ; Anesthetics ; Neuromuscular Nondepolarizing Agents ; gamma-Cyclodextrins ; Neostigmine (3982TWQ96G) ; Rocuronium (WRE554RFEZ)
Language	English
Publishing date	2022-05-01
Publishing country	France
Document type	Journal Article
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.14463
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Article ; Online: An in vitro analysis of the dead space in 5 supraglottic airway devices intended for use in small children and infants.

Templeton, Thomas Wesley / Goenaga-Díaz, Eduardo J / Templeton, Leah B / Ririe, Douglas G

Paediatric anaesthesia

2018 Volume 28, Issue 6, Page(s) 570–572

MeSH term(s)	Child, Preschool ; Equipment Design ; Humans ; In Vitro Techniques ; Infant ; Intubation, Intratracheal/instrumentation ; Laryngeal Masks
Language	English
Publishing date	2018-03-30
Publishing country	France
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	1086049-6
ISSN	1460-9592 ; 1155-5645
ISSN (online)	1460-9592
ISSN	1155-5645
DOI	10.1111/pan.13382
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Article ; Online: Mechanical sensibility of nociceptive and non-nociceptive fast-conducting afferents is modulated by skin temperature.

Boada, M Danilo / Eisenach, James C / Ririe, Douglas G

Journal of neurophysiology

2015 Volume 115, Issue 1, Page(s) 546–553

Abstract: The ability to distinguish mechanical from thermal input is a critical component of peripheral somatosensory function. Polymodal C fibers respond to both stimuli. However, mechanosensitive, modality-specific fast-conducting tactile and nociceptor ... ...

Abstract	The ability to distinguish mechanical from thermal input is a critical component of peripheral somatosensory function. Polymodal C fibers respond to both stimuli. However, mechanosensitive, modality-specific fast-conducting tactile and nociceptor afferents theoretically carry information only about mechanical forces independent of the thermal environment. We hypothesize that the thermal environment can nonetheless modulate mechanical force sensibility in fibers that do not respond directly to change in temperature. To study this, fast-conducting mechanosensitive peripheral sensory fibers in male Sprague-Dawley rats were accessed at the soma in the dorsal root ganglia from T11 or L4/L5. Neuronal identification was performed using receptive field characteristics and passive and active electrical properties. Neurons responded to mechanical stimuli but failed to generate action potentials in response to changes in temperature alone, except for the tactile mechanical and cold sensitive neurons. Heat and cold ramps were utilized to determine temperature-induced modulation of response to mechanical stimuli. Mechanically evoked electrical activity in non-nociceptive, low-threshold mechanoreceptors (tactile afferents) decreased in response to changes in temperature while mechanically induced activity was increased in nociceptive, fast-conducting, high-threshold mechanoreceptors in response to the same changes in temperature. These data suggest that mechanical activation does not occur in isolation but rather that temperature changes appear to alter mechanical afferent activity and input to the central nervous system in a dynamic fashion. Further studies to understand the psychophysiological implications of thermal modulation of fast-conducting mechanical input to the spinal cord will provide greater insight into the implications of these findings.
MeSH term(s)	Action Potentials ; Animals ; Cold Temperature ; Ganglia, Spinal/physiology ; Hot Temperature ; Male ; Mechanoreceptors/physiology ; Nociception/physiology ; Nociceptors/physiology ; Physical Stimulation ; Rats ; Rats, Sprague-Dawley ; Skin Temperature ; Touch/physiology
Language	English
Publishing date	2015-11-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80161-6
ISSN	1522-1598 ; 0022-3077
ISSN (online)	1522-1598
ISSN	0022-3077
DOI	10.1152/jn.00796.2015
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