Neuroapoptosis in newborns with respiratory acidosis at birth.

BACKGROUND: S100B protein is one of the most accurate biomarkers for diagnosis of neuroapoptosis and brain damage. The aim was to evaluate the lactate concentration and acid-base balance (pH, pCO2, pO2, HCO3c and BEb) in umbilical cord blood to predict high risk of neuroapoptosis and analyze the relationship between the levels of these biomarkers and umbilical cord blood S100B protein concentration at birth. METHODS: Apparently healthy newborns were included. S100B protein and blood gas test (lactate and acid-base balance) were determined in umbilical cord blood at birth. Newborns were classified into two groups: with and without high risk of neuroapoptosis. Newborns with high umbilical cord blood S100B protein concentration were considered newborns at high risk of neuroapoptosis. RESULTS: Sixty-one newborns were included, 12 had high risk of neuroapoptosis and 49 did not. S100B protein concentration correlate directly with pCO2 levels (Rho: 0.286, p = .0321) and lactate concentration (Rho: 0.278, p = .0315); and indirectly with pH (Rho: -0.332, p = .01). The analysis of the ROC curves yielded significant curves for pH and pCO2 to predict high risk of neuroapoptosis, pH optimal cutoff value was 7.19 (sensitivity: 50%, specificity: 83.7%, AUC: 0.708); and pCO2 optimal cutoff value was 60 mmHg (sensitivity: 30%, specificity: 85.4%, AUC: 0.705). CONCLUSIONS: Respiratory acidosis is associated to high concentrations of S100B protein in umbilical cord blood at birth. Umbilical cord blood pH and pCO2 may be useful in differentiating newborns at high risk of neuroapoptosis. Umbilical cord blood gas test may be valuable as risk indicator for neuroapoptosis at birth.

Efecto neuroprotector del sevoflurano en anestesia general / Neuroprotective effect of sevoflurane in general anaesthesia

Introducción y objetivo: El objetivo fue evaluar el daño cerebral producido por el sevoflurano inhalado mediante la determinación de la proteína S100B sérica antes y después de una exposición a este fármaco como único agente anestésico. Pacientes y método: Se incluyeron pacientes pediátricos sometidos a resonancia magnética nuclear bajo anestesia general con sevoflurano inhalado a dosis baja. A todos los pacientes se les extrajo una muestra de sangre venosa, antes (muestra basal) y después de la anestesia general (muestra postexposición). Se determinó la concentración de la proteína S100B sérica en la muestra basal (S100Bb) y en la muestra postexposición (S100Bp). Resultados: Se incluyeron 72 pacientes entre 2 y 13 años (mediana = 6), 28 niños y 44 niñas. Los valores de S100Bp (mediana = 66,5 ng/l) fueron significativamente inferiores (p = 0,0059) a los de S100Bb (mediana = 84,0 ng/l). La mediana de las diferencias entre S100Bp y S100Bb resultó −11,0 ng/l. Conclusiones: El sevoflurano inhalado a dosis bajas produce un descenso de la proteína S100B sérica, por lo que este fármaco podría tener un efecto neuroprotector a nivel del sistema nervioso central (AU)

Introduction and objective: The aim of this study was to evaluate the brain damage caused by inhaled sevoflurane, by determining the concentration of serum S100B protein before and after the exposure to this drug as the only anaesthetic agent. Patients and method: Paediatric patients undergoing general anaesthesia for the conduct of a nuclear magnetic resonance were included in the study. A venous blood sample was taken from each patient before (basal sample) and after (post-exposure sample) administering the general anaesthesia. The concentration of serum S100B protein was determined in the basal (S100Bb) and post-exposure sample (S100Bp). Results: A total of 72 patients were included in the study, with a mean patient age of 2 to 13 years (median = 6), 28 males and 44 females. S100Bp values (median = 66.5 ng/L) were significantly lower (P = .0059) than those of S100Bb (median = 84.0 ng/L). The median of the difference between S100Bp and S100Bb was −11.0 ng/L. Conclusions: Inhaled sevoflurane at low doses causes a decrease of serum S100B protein levels, hence, this drug could have a neuroprotective effect in the central nervous system (AU)

Neuroprotective effect of sevoflurane in general anaesthesia. / Efecto neuroprotector del sevoflurano en anestesia general.

INTRODUCTION AND OBJECTIVE: The aim of this study was to evaluate the brain damage caused by inhaled sevoflurane, by determining the concentration of serum S100B protein before and after the exposure to this drug as the only anaesthetic agent. PATIENTS AND METHOD: Paediatric patients undergoing general anaesthesia for the conduct of a nuclear magnetic resonance were included in the study. A venous blood sample was taken from each patient before (basal sample) and after (post-exposure sample) administering the general anaesthesia. The concentration of serum S100B protein was determined in the basal (S100Bb) and post-exposure sample (S100Bp). RESULTS: A total of 72 patients were included in the study, with a mean patient age of 2 to 13 years (median=6), 28 males and 44 females. S100Bp values (median=66.5ng/L) were significantly lower (P=.0059) than those of S100Bb (median=84.0ng/L). The median of the difference between S100Bp and S100Bb was -11.0ng/L. CONCLUSIONS: Inhaled sevoflurane at low doses causes a decrease of serum S100B protein levels, hence, this drug could have a neuroprotective effect in the central nervous system.

Daño cerebral postanestesia general / Brain damage after general anesthesia

Fundamento y objetivo: La proteína S100B es un marcador sérico de daño cerebral. El objetivo fue evaluar el daño cerebral producido por la anestesia general mediante la determinación de la concentración de proteína S100B sérica antes y después de la anestesia general. Pacientes y método: Se incluyeron pacientes con intervención quirúrgica programada de amigdalectomía por hipertrofia amigdalar. En la consulta de preanestesia se extrajo una muestra de sangre venosa (muestra basal). Los pacientes fueron sometidos a anestesia general utilizando los siguientes fármacos anestésicos intravenosos: midazolam, fentanilo y propofol; y sevoflurano inhalado. Al finalizar la intervención quirúrgica y con el paciente aún en quirófano, se extrajo una segunda muestra de sangre venosa (muestra postexposición). Se determinó en suero la concentración de la proteína S100B en la muestra basal (S100Bb) y en la muestra postexposición (S100Bp), mediante inmunoanálisis de electroquimioluminiscencia en el MODULAR E-170 (Roche Diagnostics). Resultados: Se incluyeron 76 pacientes, 46 varones y 30 hembras, con edades entre 3 y 14 años (mediana 5 años). En todos los pacientes, los niveles de proteína S100B sérica aumentaron tras la anestesia general. Los valores obtenidos de S100Bp (mediana 164,0 ng/l) fueron significativamente mayores que los obtenidos de S100Bb (mediana 94,5 ng/l). La mediana de la diferencia entre S100Bp y S100Bb fue de 58,0 ng/l. Mediante el test de Wilcoxon se encontraron diferencias estadísticamente significativas entre S100Bb y S100Bp (p < 0,0001). Conclusiones: La concentración de proteína S100B sérica aumentó significativamente tras la anestesia general. Esto indica que la anestesia general puede producir daño cerebral (AU)

Background and objective: S100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anaesthesia, by determining the concentration of serum S100B protein before and after of general anaesthesia. Patients and method: Patients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anaesthesia (basal sample). The patients were anaesthetised using the following intravenous anaesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). Results: Seventy-six patients were included, 46 males and 30 females, aged between 3 to 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anaesthesia. The values of S100Bp (median 164.0 ng/L) were significantly higher than the values of S100Bb (median 94.5 ng/L). The median of the difference between S100Bp and S100Bb was 58.0 ng/L. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (P < .0001). Conclusions: The concentration of serum S100B protein increased significantly after general anaesthesia. This indicates that general anaesthesia may cause brain damage (AU)

[Brain damage after general anesthesia]. / Daño cerebral postanestesia general.

BACKGROUND AND OBJECTIVE: S100B protein is a serum marker of cerebral damage. The objective was to evaluate the brain damage caused by general anaesthesia, by determining the concentration of serum S100B protein before and after of general anaesthesia. PATIENTS AND METHOD: Patients with chronic adenotonsillar hypertrophy and indications for tonsillectomy were included. A venous blood sample was taken from the patients before general anaesthesia (basal sample). The patients were anaesthetised using the following intravenous anaesthetic drugs: midazolam, fentanyl and propofol; and inhaled sevoflurane. A second venous blood sample (postoperative sample) was taken from patients after the surgery, in the operating room. The concentration of serum S100B protein was determined in the basal sample (S100Bb) and postoperative sample (S100Bp) by immunoassay electro-chemiluminescence in MODULAR E-170 (Roche Diagnostics). RESULTS: Seventy-six patients were included, 46 males and 30 females, aged between 3 to 14 (median 5 years). In all the patients, serum S100B protein levels increased after general anaesthesia. The values of S100Bp (median 164.0 ng/L) were significantly higher than the values of S100Bb (median 94.5 ng/L). The median of the difference between S100Bp and S100Bb was 58.0 ng/L. There were statistically significant differences between S100Bb and S100Bp using the Wilcoxon test (P<.0001). CONCLUSIONS: The concentration of serum S100B protein increased significantly after general anaesthesia. This indicates that general anaesthesia may cause brain damage.