Consideraciones anestésicas para el abordaje del paciente quirúrgico con COVID-19 / Anesthetic considerations for the management of the surgical patient with COVID-19

Resumen Introducción: La situación actual causada por el COVID-19 demanda la implementación de nuevas técnicas en el manejo anestésico y los riesgos preexistentes en los servicios quirúrgicos. Objetivo: Identificar las consideraciones anestésicas para pacientes con COVID-19 con el fin de sugerir intervenciones en el área quirúrgica. Metodología: Revisión integrativa de alcance descriptivo en conjunto con el cumplimiento de los pasos metodológicos de Whittemore-Knafl y los parámetros PRISMA. Se realizó la búsqueda en las bases de datos: PubMed, BVS, Coronavirus Research Database, SCOPUS, Elsevier y SAGE. Se obtuvieron 953 artículos que, junto a un análisis crítico por CASPe, cumplieron los criterios establecidos de inclusión y exclusión. Resultados: Se seleccionaron 27 artículos clasificados en: criterios de selección de técnica anestésica; anestesia general y el uso de medicamentos específicos para el manejo anestésico que disminuyan la tos y prevengan la liberación de aerosoles; manejo de la vía aérea encaminada a evitar intubaciones fallidas; anestesia regional y consideraciones de enfermería sobre la preparación de elementos y dispositivos de manera previa al ingreso del paciente al quirófano; identificación y monitorización de pacientes sintomáticos y asintomáticos durante el proceso perioperatorio. Conclusión: Con respecto a la técnica anestésica, es importante priorizar el uso, en cuanto sea posible, de la anestesia regional guiada con ultrasonido. En caso de requerirse la anestesia general, es recomendable mantener las precauciones para prevenir el contagio con el virus. Para enfermería, es destacable el rol en la preparación de un entorno quirúrgico seguro, del conocimiento sobre la técnica anestésica empleada y los cuidados individualizados según las necesidades requeridas.

Abstract Introduction: The current situation caused by COVID-19 demands the implementation of new techniques in anesthetic management and pre-existing risks in surgical services. Objective: to identify the anesthetic considerations for patients with COVID-19 to suggest interventions in the surgical area. Methodology: Integrative review of descriptive scope in conjunction with compliance with the methodological steps of Whittemore-Knafl and the PRISMA parameters. The search was performed in the following databases: PubMed, VHL, Coronavirus Research Database, SCOPUS, Elsevier, and SAGE. A total of 953 articles were obtained, which together with a critical analysis by CASPe, met the established inclusion and exclusion criteria. Results: Twenty-seven articles classified as: selection criteria for anesthetic techniques; general anesthesia and the use of specific medications for anesthetic management that reduce cough and prevent the release of aerosols; airway management to avoid failed intubations; regional anesthesia and nursing considerations in the preparation of elements and devices prior to the patient's admission to the operating room; identification and follow-up of symptomatic and asymptomatic patients during the perioperative process. Conclusion: Regarding the anesthetic technique, it is important to prioritize the use, as far as possible, of ultrasound-guided regional anesthesia. If general anesthesia is required, it is advisable to maintain precautions to prevent infection with the virus. For nursing, the role in preparing a safe surgical environment, knowledge of the anesthetic technique used and individualized care according to the required needs stand out.

Desipramine or glutamate antagonists synergized the antidepressant-like actions of intra-nucleus accumbens infusions of minocycline in male Wistar rats.

Minocycline produces antidepressant-like actions in male rats tested in the forced swimming test (FST) and synergizes with several glutamate receptor antagonists. However, the limbic regions implicated in the antidepressant-like actions of minocycline are unknown. The objective of the present study was to test the potential antidepressant activity of nucleus accumbens infusions of minocycline alone or combined with antidepressant drugs or with several glutamate receptor antagonists, using the time-sampling method in the FST. The results show that intra-NAcc infusions of minocycline reduced immobility (1.0 microg, P<0.05; 1.5 microg, P<0.05) by increasing climbing (1.0 microg, P<0.05; 1.5 microg, P<0.05) in the FST. Likewise, systemic injections of desipramine (P<0.05), fluoxetine (P<0.05) or several glutamate receptor antagonists: EMQMCM (P<0.05), MTEP (P<0.05) or dizocilpine (P<0.05) combined with intra-nucleus accumbens infusions of vehicle produced antidepressant-like actions. The subthreshold dose of intra-nucleus accumbens infusions of minocycline combined with systemic injections of subthreshold doses of desipramine (P<0.05) or EMQMCM (P<0.05) or MTEP (P<0.05) or dizocilpine (P<0.05) produced antidepressant-like actions. It is concluded that intra-NAcc infusions of minocycline alone or combined with systemic injections of desipramine or with systemic injections of several glutamate receptor antagonists produced antidepressant-like actions in the FST.

Antidepressant-like actions of minocycline combined with several glutamate antagonists.

This study tested the potential antidepressant activity of minocycline alone or combined with two traditional antidepressant drugs or several glutamate receptor antagonists, using the time sampling method in the forced swimming test. Results showed that: desipramine (10.0 mg/kg, P<0.05; 15.0 mg/kg, P<0.05), minocycline (60.0 mg/kg, P<0.05; 80.0 mg/kg, P<0.05) and EMQMCM (1.5 mg/kg, P<0.05; 2.0 mg/kg, P<0.05), reduced immobility by increasing climbing. Fluoxetine (20.0 mg/kg, P<0.05; 25.0 mg/kg, P<0.05) reduced immobility by increasing swimming. MTEP (5.0 mg/kg, P<0.05; 10.0 mg/kg, P<0.05) and dizolcipine (1.0 mg/kg, P<0.05; 1.5 mg/kg, P<0.05) reduced immobility by increasing swimming and climbing. Combination experiments showed that a subthreshold dose of minocycline (50.0 mg/kg) synergized the antidepressant-like actions of subthreshold doses of: desipramine (5.0 mg/kg; P<0.05), EMQMCM (0.6 mg/kg; P<0.05), MTEP (2.5 mg/kg; P<0.05) and dizolcipine (0.5 mg/kg; P<0.05). In conclusion, minocycline produced antidepressant-like actions in the FST and subthreshold dose of minocycline combined with subthreshold dose of desipramine and several glutamate receptor antagonists and produced antidepressant-like actions.

Antidepressant-like and anxiolytic-like actions of the mGlu5 receptor antagonist MTEP, microinjected into lateral septal nuclei of male Wistar rats.

This study describes the effects of intra-lateral septal infusions of different doses of the mGluR5 antagonist MTEP in the DRL-72 s paradigm and the elevated plus-maze test in rats, two behavioral models known to be sensitive to antidepressant-like and anxiolytic-like drug effects, respectively. Intra-lateral septal infusions of MTEP induced a dose-dependent (5.0 microg/microl, P<0.05; 10.0 microg/microl, P<0.05) increase in reinforced lever presses and a cohesive rightward shift of the inter-response time distribution (5.0 microg/microl, P<0.05; 10.0 microg/microl, P<0.05). These effects are indicative of antidepressant-like actions of the compound. Desipramine, a prototypical antidepressant drug, induced (5.0 microg/microl; P<0.05) similar effects. In the elevated plus-maze test, intra-lateral septal infusions of MTEP (5.0 microg/microl, P<0.05; 10.0 microg/microl, P<0.05) increased the exploration of the open arms without affecting locomotion. This anxiolytic-like effect was similar to that observed with the infusion of the benzodiazepine midazolam (10.0 microg/microl; P<0.05) in the same brain area. It is concluded that intra-lateral septal infusions of the mGlu5 receptor antagonist MTEP produced antidepressant-like actions or anxiolytic-like effects in male rats.

Synergistic interaction between ketoconazole and several antidepressant drugs with allopregnanolone treatments in ovariectomized Wistar rats forced to swim.

This article was aimed to investigate the interest of the combination allopregnanolone plus ketoconazole in depression with the time-sampling method in the forced swimming task. Dose-response curves for fluoxetine (0.5, 1.0 or 2.0 mg/kg, twice day, during 2 weeks; i.p.), desipramine (0.5, 1.0 or 2.14 mg/kg, twice a day, during 2 weeks; i.p.), ketoconazole (6.25, 12.5, 25.0 and 37.5 mg/kg, once a day, during 2 weeks; i.p.) and allopregnanolone (0.5, 1.5, 2.0 mg/kg; once a day, during 2 weeks; s.c.) were established. Fluoxetine (1.0 mg/kg, p < 0.05; 2.0 mg/kg, p < 0.05) or ketoconazole (25.0 mg/kg, p < 0.05; 37.5 mg/kg, p < 0.05) produced antidepressant-like behavioral changes in swimming, highlighting a serotonergic mechanism while desipramine (1.0 mg/kg, p < 0.05; 2.14 mg/kg, p < 0.05) or allopregnanolone (1.5 mg/kg, p < 0.05; 2.0 mg/kg, p < 0.05) increased climbing behavior highlighting noradrenergic or dopaminergic effects. Subthreshold doses of fluoxetine (p < 0.05), desipramine (p < 0.05) or ketoconazole (p < 0.05) synergized with subthreshold doses of allopregnanolone and reduced immobility by increasing climbing. In conclusion, fluoxetine, desipramine, ketoconazole and allopregnanolone produced differential antidepressant-like actions in ovariectomized rats forced to swim. Ketoconazole, fluoxetine or desipramine synergized with allopregnanolone.

Female Wistar rats tested during late proestrus or during pregnancy and ovariectomized rats tested after receiving progesterone or allopregnanolone displayed reduced conflict behavior.

In a conflict test based on the rat's choice between an immediate punished reinforcer or a delayed nonpunished reinforcer, anxiolytic drugs increase the number of immediate punished reinforcers. In this study, two hypotheses were tested: first, during late proestrus or during midpregnancy, female rats will display an elevated amount of immediate punished reinforcers; second, ovariectomized rats will display an elevated amount of immediate punished reinforcers when they receive anxiolytic doses of neurosteroids. Thus, female rats (n = 15) were tested repeatedly during late proestrus, diestrus, and pregnancy in the aforementioned conflict task. They displayed an elevated amount of immediate punished reinforcers during late proestrus (P < .05) and during the 14th (P < .05) and 17th (P < .05) days of pregnancy compared to diestrus or 3rd, 7th, or 20th days of pregnancy. Likewise, ovariectomized rats (n = 90) displayed an elevated amount of immediate punished reinforcers compared to control rats only when they received anxiolytic doses of progesterone (1.0-2.0 mg/kg, P < .05) or allopregnanolone (1.0-2.0 mg/kg, P < .05). In conclusion, female rats displayed reduced conflict behavior during late proestrus and pregnancy, or after received anxiolytic doses of neurosteroids.