[Perioperative anesthetic management of a patient with multiple sclerosis].

We report general anesthesia for a patient with multiple sclerosis (MS). A 40-year-old male patient with a 13-year history of MS was scheduled for laparoscopic surgery. The symptoms of MS had been exacerbated during feverish state or under surgical stress in the previous surgeries. To prevent surgical stress response and postoperative fever, we performed epidural anesthesia with continuous intravenous infusion of propofol and fentanyl during surgery. Flurbiprofen axetil was used for slight postoperative fever. There was no clinical exacerbation of MS during perioperative period. In conclusion, appropriate control of surgical stress and prevention of fever are important for perioperative anesthetic management of patients suffering from MS.

Orexin a elicits arousal electroencephalography without sympathetic cardiovascular activation in isoflurane-anesthetized rats.

UNLABELLED: We studied the effects of intracerebroventricular injection of the novel neuropeptide orexin A on electroencephalogram (EEG) and autonomic nervous system activity in rats under isoflurane anesthesia. The administration of orexin A changed burst suppression patterns to arousal patterns on the EEG at 1.0 minimum alveolar anesthetic concentration (MAC) isoflurane and decreased the burst suppression ratio at 1.5 MAC isoflurane. However, orexin A did not influence the heart rate or mean arterial blood pressure at either isoflurane concentration. These findings demonstrated that orexin A elicited anesthetic arousal under isoflurane anesthesia in terms of EEG pattern without sympathetic cardiovascular activation in the rat. IMPLICATIONS: The novel neuropeptides orexins induce arousal associated with activation of the sympathetic nervous system in conscious rats. It is not known whether orexins affect the electroencephalogram (EEG), autonomic nerve activity, or both under anesthesia. Orexin A induced EEG arousal without sympathetic cardiovascular activation in the isoflurane-anesthetized rat. Orexin A might influence the depth of anesthesia.

Isoflurane ameliorates the posthypoxic deoxygenation of the rat brain--the role of cell adhesion molecules of polymorphonuclear leukocytes.

One of the serious problems that occurs after cardiopulmonary resuscitation is brain posthypoxic/ischemic deoxygenation. However, there has been no report concerning the effect of isoflurane (ISO) on the brain oxygenation during hypoxia-reoxygenation in relation to cell adhesion molecules (CD11b) in polymorphonuclear leukocyte. Rats were anesthetized with a low concentration of ISO (0.5 MAC: low ISO) or high concentration of ISO (1.5 MAC: high ISO) and brain oxygenation was detected by near infrared spectroscopy during 10-min hypoxia (5% O(2)) and a subsequent 120-min reoxygenation period. Hypoxia induced a decrease in oxyhemoglobin (HbO(2)) and an increase in deoxyhemoglobin (Hb). Reoxygenation induced a significant decrease in total hemoglobin (tHb) and HbO(2) with low ISO, but not with high ISO. The changes in Hb were minimal during reoxygenation in both groups. CD11b increased during reoxygenation with low ISO anesthetization, but not with high ISO. A significant negative correlation was observed between CD11b and two of the measured oxyparameters, HbO(2) and tHb, during reoxygenation at low ISO, but not at high ISO. These findings suggest that brain deoxygenation during hypoxia-reoxygenation is partly related to the expression of CD11b. We conclude that ISO modifies the brain circulation at least in part through attenuating the expression of CD11b during hypoxia-reoxygenation.