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2.
Medicine (Baltimore) ; 100(4): e24495, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530271

RESUMO

RATIONALE: Sevoflurane-induced seizures are most often caused by high concentrations of sevoflurane during anesthesia induction. However, in this case, we found a rare case of seizure-like movements caused by residual sevoflurane inside the anesthesia machine. Therefore, we propose that the detection of residual anesthesia-inhaled drugs should be included in pre-anesthesia checkout procedures. PATIENT CONCERNS: An 11-year-old girl with a history of epilepsy was scheduled for emergency appendectomy under general anesthesia. The patient presented with seizure-like movements caused by residual sevoflurane inside the anesthesia machine after pre-oxygenation during rapid sequence induction. DIAGNOSES: Based on the clinical presentation and previous history of seizures, sevoflurane-induced seizures were diagnosed. INTERVENTIONS: A washout procedure was performed by turning the oxygen flow up to 10L/min to wash out the residual sevoflurane from the anesthesia machine. OUTCOMES: The seizures ceased spontaneously, and the vital signs of the patient were stable during the washout procedure. Rapid sequence anesthesia induction and total intravenous anesthesia maintenance were uneventful. Surgery was performed as planned, and there were no postoperative problems. The patient was discharged after 4 days without complications and was well on follow-up. LESSONS: The check-up procedure of residual anesthesia-inhaled drugs inside the anesthesia machine should be included in the checkout design guidelines, or else the washout procedure should be performed in the pre-anesthesia checkout procedures.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Convulsões/induzido quimicamente , Sevoflurano/efeitos adversos , Anestesia Geral/efeitos adversos , Anestesia Geral/instrumentação , Criança , Feminino , Humanos
3.
Medicine (Baltimore) ; 100(1): e24160, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429798

RESUMO

ABSTRACT: Postoperative delirium (PODE) can be associated with severe clinical complications; therefore, preventive measures are important. The objective of this trial was to elucidate whether haemodynamic or electroencephalographic (EEG) monitoring parameters during general anaesthesia or sevoflurane dosage correlate with the incidence of PODE. In addition, sevoflurane dosages and EEG stages during the steady state of anaesthesia were analyzed in patients of different ages.Eighty adult patients undergoing elective abdominal surgery received anaesthesia with sevoflurane and sufentanil according to the clinical routine. Anaesthesiologists were blinded to the EEG. Haemodynamic parameters, EEG parameters, sevoflurane dosage, and occurrence of PODE were analyzed.Thirteen patients (4 out of 33 women, 9 out of 47 men) developed PODE. Patients with PODE had a greater mean arterial pressure (MAP) variance (267.26 (139.40) vs 192.56 (99.64) mmHg2, P = .04), had a longer duration of EEG burst suppression or suppression (27.09 (45.32) vs 5.23 (10.80) minutes, P = .03), and received higher minimum alveolar sevoflurane concentrations (MAC) (1.22 (0.22) vs 1.09 (0.17), P = .03) than patients without PODE. MAC values were associated with wide ranges of EEG index values representing different levels of hypnosis.The results suggest that, in order to prevent PODE, a great variance of MAP, higher doses of sevoflurane, and deep levels of anaesthesia should be avoided. Titrating sevoflurane according to end-tidal gas monitoring and vital signs can lead to unnecessarily deep or light hypnosis. Intraoperative EEG monitoring may help to prevent PODE.


Assuntos
Delírio/classificação , Delírio/etiologia , Monitorização Intraoperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Inalatórios/efeitos adversos , Anestésicos Inalatórios/uso terapêutico , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Sevoflurano/efeitos adversos , Sevoflurano/uso terapêutico , Sufentanil/efeitos adversos , Sufentanil/uso terapêutico
4.
Anesthesiology ; 134(3): 381-394, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33439974

RESUMO

BACKGROUND: Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur. METHODS: A randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery. RESULTS: A total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups. CONCLUSIONS: Anesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery.


Assuntos
Abdome/cirurgia , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Complicações Cognitivas Pós-Operatórias/epidemiologia , Propofol/efeitos adversos , Sevoflurano/efeitos adversos , Idoso , Anestésicos Inalatórios/sangue , Anestésicos Intravenosos/sangue , Biomarcadores/sangue , China/epidemiologia , Método Duplo-Cego , Feminino , Avaliação Geriátrica/métodos , Avaliação Geriátrica/estatística & dados numéricos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Complicações Cognitivas Pós-Operatórias/sangue , Propofol/sangue , Sevoflurano/sangue
5.
Anaesthesia ; 76(1): 36-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32743803

RESUMO

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (Sp O2  < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Desflurano/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Transtornos Respiratórios/epidemiologia , Sevoflurano/efeitos adversos , Adulto , Fatores Etários , Idoso , Extubação , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Transtornos Respiratórios/terapia , Fatores de Risco , Resultado do Tratamento
6.
Environ Mol Mutagen ; 62(2): 155-164, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33341964

RESUMO

Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.


Assuntos
Anestesia/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Dano ao DNA/efeitos dos fármacos , Expressão Gênica/efeitos dos fármacos , Inflamação/induzido quimicamente , Exposição Ocupacional/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Adulto , Idoso , Poluentes Ocupacionais do Ar/efeitos adversos , Antioxidantes/metabolismo , Reparo do DNA/efeitos dos fármacos , Feminino , Hospitais , Humanos , Inflamação/metabolismo , Isoflurano/efeitos adversos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso/efeitos adversos , Sevoflurano/efeitos adversos
7.
Anesth Analg ; 131(4): 1291-1299, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925350

RESUMO

BACKGROUND: Neonatal exposure to sevoflurane induces neurobehavioral and neuroendocrine abnormalities in exposed male rats (generation F0) and neurobehavioral, but not neuroendocrine, abnormalities in their male, but not female, offspring (generation F1). These effects of sevoflurane are accompanied by a hypermethylated neuron-specific K-2Cl (Kcc2) Cl exporter gene in the F0 spermatozoa and the F1 male hypothalamus, while the gene's expression is reduced in the F0 and F1 hypothalamus. We investigated whether inhibition of deoxyribonucleic acid methyltransferases (DNMTs) before paternal sevoflurane exposure could alleviate the anesthetic's F0 and F1 effects. METHODS: Sprague-Dawley male rats were anesthetized with 2.1% sevoflurane for 5 hours on postnatal day (P) 5 and mated with control females on P90 to generate offspring. The nonselective DNMT inhibitor decitabine (0.5 mg/kg, intraperitoneally) was administered 30 minutes before sevoflurane exposure. The F0 and F1 male rats were evaluated in in vivo and in vitro tests in adulthood. RESULTS: Paternal exposure to sevoflurane induced impaired prepulse inhibition of the acoustic startle response and exacerbated corticosterone responses to stress in F0 males and impaired prepulse inhibition of the startle responses in F1 males. These effects were accompanied in both generations by reduced and increased expressions of hypothalamic Kcc2 and Dnmt3a/b, respectively. Decitabine deterred the effects of paternal exposure to sevoflurane in F0 and F1 males. CONCLUSIONS: These results suggest that similar decitabine-sensitive mechanisms regulating expression of multiple genes are involved in the mediation of neurobehavioral abnormalities in sires neonatally exposed to sevoflurane and in their future unexposed male offspring.


Assuntos
Anestesia por Inalação/efeitos adversos , Anestésicos Inalatórios/efeitos adversos , Antimetabólitos Antineoplásicos/uso terapêutico , Decitabina/uso terapêutico , Exposição Paterna/efeitos adversos , Sevoflurano/efeitos adversos , Animais , Animais Recém-Nascidos , Corticosterona/metabolismo , Metilases de Modificação do DNA/antagonistas & inibidores , Feminino , Masculino , Ratos , Ratos Sprague-Dawley , Reflexo de Sobressalto/efeitos dos fármacos , Estresse Psicológico/metabolismo , Simportadores/antagonistas & inibidores
8.
Khirurgiia (Mosk) ; (8): 69-74, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32869618

RESUMO

OBJECTIVE: To substantiate the advisability of using cytoflavin to correct postoperative cognitive dysfunction (POCD) in patients undergoing video laparoscopic cholecystectomy (VLCE) under conditions of inhalation anesthesia with sevoflurane. MATERIAL AND METHODS: The data of two representative groups of patients (n=60) who underwent video-laparoscopic cholecystectomy under the conditions of inhalation anesthesia with sevoflurane were analyzed. At the stages of the perioperative period, in order to monitor the state of higher mental functions, neuropsychological testing was performed: anxiety and depression scales (HADS), the Montreal scale of cognitive dysfunction (MoCA), and frontal dysfunction batteries (FAB). Patients of the first group (n=19) were not corrected for POKD. For the correction of cognitive impairment, patients of the second group (n=41) were treated with Cytoflavin according to the 20 ml regimen per 250 ml of 0.9% sodium chloride solution intravenously once before the operation, then within 4 days of the postoperative period. RESULTS: Neuropsychological testing in group I patients revealed the development of moderate POCD. The inclusion of Cytoflavin in the treatment regimen in the II group of patients contributed to an improvement in the state of HMF, accompanied by a decrease in the level of anxiety and depression. CONCLUSION: The inclusion of Cytoflavin in treatment regimens helps prevent the development of POKD and is accompanied by an improvement in the state of higher mental functions, which is manifested by a decrease in the level of anxiety and depression, favorably affecting the emotional background of patients.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Colecistectomia Laparoscópica , Transtornos Cognitivos/terapia , Mononucleotídeo de Flavina/administração & dosagem , Inosina Difosfato/administração & dosagem , Fármacos Neuroprotetores/administração & dosagem , Niacinamida/administração & dosagem , Sevoflurano/efeitos adversos , Succinatos/administração & dosagem , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/métodos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Combinação de Medicamentos , Humanos , Cirurgia Vídeoassistida
9.
Intensive Care Med ; 46(8): 1563-1566, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32588067

RESUMO

Hospitals worldwide are experiencing a shortage in essential intravenous sedative medications. This is attributable to high number and high sedative needs of COVID-19 critical care patients with disruption of drug supply chains. Inhaled volatile anesthetic agents are an abundant resource and readily implementable solution for providing ICU sedation. Inhaled volatile agents may also provide important pulmonary benefits for COVID-19 patients with ARDS that could improve gas exchange and reduce time spent on a ventilator. We review the use of volatile agents, and provide a technical overview and algorithm for administering inhaled volatile-based sedation in ICUs.


Assuntos
Anestésicos Inalatórios , Betacoronavirus , Infecções por Coronavirus/complicações , Hipnóticos e Sedativos/administração & dosagem , Pneumonia Viral/terapia , /terapia , Algoritmos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/provisão & distribução , Humanos , Isoflurano , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/etiologia , Sevoflurano/efeitos adversos
10.
Zhongguo Zhen Jiu ; 40(3): 243-6, 2020 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-32270634

RESUMO

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative olfactory memory disorder in patients with general anesthesia of sevoflurane and to explore its possible mechanism. METHODS: Forty patients who were scheduled to have gynecological and urological procedures under general anesthesia were randomly divided into an observation group and a control group, 20 cases in each group. The patients in the observation group were treated with TEAS (dilatational wave, 2 Hz/100 Hz) at Yingxiang (LI 20) and Yintang (GV 29) 10 min before anesthesia induction until the end of operation; the patients in the control group received general anesthesia directly. The changes of mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SpO2) were recorded before treatment, 30 min after operation and at the end of operation; smell identification score was measured by Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test before treatment (T0) and when Aldrete recovery score reached 10 points at the end of anesthesia (T1); the concentration of melatonin in plasma was measured by ELISA method in the two groups. RESULTS: The between-group differences and within-group differences of MAP, HR and SpO2 were not significant at each time point (P>0.05). Compared with T0, the score of smell identification and plasma concentration of melatonin were not significantly different at T1 in the observation group (P>0.05), however, the score of smell identification and plasma concentration of melatonin were reduced in the control group (P<0.05). At T1, the score of smell identification and plasma concentration of melatonin in the observation group were higher than those in the control group (P<0.05). CONCLUSION: TEAS could improve the postoperative olfactory memory disorder in patients with general anesthesia of sevoflurane, and its mechanism may be related to the increase of plasma concentration of melatonin.


Assuntos
Pontos de Acupuntura , Melatonina/sangue , Transtornos do Olfato/induzido quimicamente , Sevoflurano/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea , Anestesia Geral/efeitos adversos , Humanos , Olfato
11.
PLoS One ; 15(4): e0231090, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32240260

RESUMO

Sevoflurane and isoflurane are among the most commonly used general anesthetics for children including infants, but their impact on metabolism, especially on blood glucose level, in children is not well understood. We investigated the impacts of anesthesia of neonatal (7-8 days old) and adult (2-3 months old) mice with the inhalational anesthetics 2.5% sevoflurane or 1.5% isoflurane, or the injectable anesthetics propofol (150 mg/kg) or avertin (375 mg/kg), for up to 6 hours. We found that sevoflurane and isoflurane induced severe hypoglycemia in neonatal mice and that this phenomenon was specific to the inhalational anesthetics because the injectable anesthetics propofol and avertin did not induce hypoglycemia. Surprisingly, the inhalational anesthesia induced hyperglycemia instead in adult mice. We also demonstrated that the inhalational anesthesia-induced hypoglycemia was a major cause of death for the neonatal mice receiving intranasal administration of saline prior to anesthesia. These studies revealed severe hypoglycemia in neonatal mice during anesthesia with sevoflurane or isoflurane. If this phenomenon also occurs in human, our findings would warrant closely monitoring blood glucose level and maintaining it in the normal range in infants receiving inhalational anesthesia.


Assuntos
Hipoglicemia/induzido quimicamente , Isoflurano/efeitos adversos , Sevoflurano/efeitos adversos , Período de Recuperação da Anestesia , Anestesia por Inalação , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Animais , Animais Recém-Nascidos , Glicemia/metabolismo , Etanol/análogos & derivados , Etanol/farmacologia , Hipoglicemia/sangue , Insulina/sangue , Camundongos Endogâmicos C57BL , Propofol/farmacologia
12.
Oxid Med Cell Longev ; 2020: 9018624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32148659

RESUMO

Various lines of evidence suggest that neonatal exposure to general anesthetics, especially repeatedly, results in neuropathological brain changes and long-term cognitive impairment. Although progress has been made in experimental models, the exact mechanism of GA-induced neurotoxicity in the developing brain remains to be clarified. Sirtuin 1 (SIRT1) plays an important role in synaptic plasticity and cognitive performance, and its abnormal reduction is associated with cognitive dysfunction in neurodegenerative diseases. However, the role of SIRT1 in GA-induced neurotoxicity is unclear to date. In this study, we found that the protein level of SIRT1 was inhibited in the hippocampi of developing mice exposed to sevoflurane. Furthermore, the SIRT1 inhibition in hippocampi was associated with brain-derived neurotrophic factor (BDNF) downregulation modulated by methyl-cytosine-phosphate-guanine-binding protein 2 (MeCP2) and cAMP response element-binding protein (CREB). Pretreatment of neonatal mice with resveratrol nearly reversed the reduction in hippocampal SIRT1 expression, which increased the expression of BDNF in developing mice exposed to sevoflurane. Moreover, changes in the levels of CREB and MeCP2, which were considered to interact with BDNF promoter IV, were also rescued by resveratrol. Furthermore, resveratrol improved the cognitive performance in the Morris water maze test of the adult mice with exposure to sevoflurane in the neonatal stage, without changing motor function in the open field test. Taken together, our findings suggested that SIRT1 deficiency regulated BDNF signaling via regulation of the epigenetic activity of MeCP2 and CREB, and resveratrol might be a promising agent for mitigating sevoflurane-induced neurotoxicity in developing mice.


Assuntos
Antioxidantes/uso terapêutico , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Síndromes Neurotóxicas/tratamento farmacológico , Resveratrol/uso terapêutico , Sevoflurano/efeitos adversos , Sirtuína 1/metabolismo , Animais , Antioxidantes/farmacologia , Humanos , Masculino , Camundongos , Resveratrol/farmacologia
13.
J Pharmacol Sci ; 143(1): 39-44, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32151542

RESUMO

We investigated effects of isoflurane and sevoflurane on sparfloxacin-induced QT-interval prolongation in guinea pigs under the monitoring of electrocardiogram and monophasic action potential (MAP), which was compared with those of halothane or non-inhaled anesthetics ketamine/xylazine. Intravenous administration of sparfloxacin at 3 and 10 mg/kg prolonged the QT interval and MAP duration together with bradycardic action under 4 different anesthetic conditions. The order of extent of prolongation of corrected QT interval after the administration of sparfloxacin was isoflurane ≈ sevoflurane ≈ halothane >> ketamine/xylazine, whereas that of the MAP90 at a pacing cycle length of 300 ms was halothane ≥ isoflurane ≈ sevoflurane >> ketamine/xylazine. These results suggest that isoflurane and sevoflurane as well as halothane could sensitize the heart to sparfloxacin-induced QT interval prolongation in guinea pigs.


Assuntos
Anestésicos Inalatórios/efeitos adversos , Isoflurano/efeitos adversos , Síndrome do QT Longo/induzido quimicamente , Sevoflurano/efeitos adversos , Potenciais de Ação/efeitos dos fármacos , Animais , Eletrocardiografia/efeitos dos fármacos , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/efeitos adversos , Cobaias , Halotano/efeitos adversos , Síndrome do QT Longo/fisiopatologia , Masculino
14.
Nat Commun ; 11(1): 642, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005799

RESUMO

Metastasis can occur following surgical resection of solid tumors and metastasis is the main cause of cancer death. The role of anesthetics used during surgery in cancer metastasis and the underlying mechanism remains largely unknown. Here we show that surgical dissection of primary tumors in mice under anesthesia with sevoflurane leads to significantly more lung metastasis than with propofol in both syngeneic murine 4T1 and xenograft human MDA-MB-231 breast cancer models. Sevoflurane increases the level of serum IL-6, which activates STAT3 and the infiltration of CD11b+ myeloid cells into the lung. Interruption of IL-6/JAK/STAT3 pathway by a JAK inhibitor AZD1480 reverses the pro-metastatic effect of sevoflurane and the associated increase of both activated STAT3 and infiltrated CD11b+ cells in 4T1 model. Our study provides the preclinical evidence informing the distinct effects of anesthetics on metastasis of breast cancers through change of cytokines and the tumor microenvironment.


Assuntos
Anestésicos Gerais/efeitos adversos , Neoplasias da Mama/cirurgia , Interleucina-6/metabolismo , Janus Quinases/metabolismo , Neoplasias Pulmonares/secundário , Fator de Transcrição STAT3/metabolismo , Anestésicos Gerais/administração & dosagem , Animais , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Modelos Animais de Doenças , Feminino , Humanos , Interleucina-6/genética , Janus Quinases/genética , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Camundongos , Camundongos Endogâmicos BALB C , Propofol/administração & dosagem , Propofol/efeitos adversos , Fator de Transcrição STAT3/genética , Sevoflurano/administração & dosagem , Sevoflurano/efeitos adversos
15.
Neurochem Res ; 45(2): 331-344, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31865521

RESUMO

Autophagy is crucial for cell survival, development, division, and homeostasis. The mammalian target of rapamycin (mTOR), which is the foremost negative controller of autophagy, plays a key role in many endogenous processes. The present study investigated whether rapamycin can ameliorate surgery-induced cognitive deficits by inhibiting mTOR and activating autophagy in the hippocampus. Both adult and aged C57BL/6J mice received an intraperitoneal injection of rapamycin (10 mg/kg/day) for 5 days per week for one and a half months. Mice were then subjected to partial hepatectomy under general anesthesia. Behavioral performance was assessed on postoperative days 3, 7, and 14. Hippocampal autophagy-related (Atg)-5, phosphorylated mTOR, and phosphorylated p70S6K were examined at each time point. Brain derived neurotrophic factor (BDNF), synaptophysin, and tau hyperphosphorylation (T396) in the hippocampus were also examined. Surgical trauma and anesthesia exacerbated spatial learning and memory impairment in aged mice on postoperative days 3 and 7. Following partial hepatectomy, the levels of phosphorylated mTOR, phosphorylated 70S6K, and phosphorylated tau were all increased in the hippocampus. A corresponding decline in BDNF and synaptophysin were observed. Rapamycin treatment restored autophagy function, attenuated phosphorylation of tau protein, and increased BDNF and synaptophysin expression in the hippocampus of surgical mice. Furthermore, surgery and anesthesia induced spatial learning and memory impairments were also reversed by rapamycin treatment. Autophagy impairments and mTOR hyperactivation were detected along with surgery-induced behavioral deficits. Inhibiting the mTOR signaling pathway with rapamycin successfully ameliorated surgery-related cognitive impairments by sustaining autophagic degradation, inhibiting tau hyperphosphorylation, and increasing synaptophysin and BDNF expression.


Assuntos
Autofagia/fisiologia , Hepatectomia/efeitos adversos , Fármacos Neuroprotetores/uso terapêutico , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/metabolismo , Fatores Etários , Animais , Hipocampo/metabolismo , Fígado/cirurgia , Masculino , Aprendizagem em Labirinto/efeitos dos fármacos , Aprendizagem em Labirinto/fisiologia , Camundongos Endogâmicos C57BL , Complicações Cognitivas Pós-Operatórias/etiologia , Sevoflurano/efeitos adversos , Regulação para Cima
16.
Cardiovasc J Afr ; 31(4): 71-74, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31512716

RESUMO

BACKGROUND: Our study aimed to compare the effects of Sevoflurane- and propofol-based anaesthetic regimens on oxygenation during the early period of cardiopulmonary bypass (CPB) in patients undergoing cardiac valve-replacement surgery. METHODS: Patients undergoing mechanical mitral, aortic or double valve replacement were enrolled and randomly divided into two groups: the sevoflurane-based anaesthetic regimen group consisted of patients who received 1-3% sevoflurane inhalation during anaesthesia maintenance and the propofol-based anaesthetic regimen group consisted of patients who received 6-10 mg/kg/h of propofol infusion during anaesthesia maintenance. The partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), respiratory mechanics and haemodynamics were recorded during CPB. RESULTS: Forty-two patients met the eligibility criteria for the study. The groups did not differ in terms of clinical and demographic characteristics, and pre- and intra-operative features. Changes in oxygenation were mild (mean PaO2/FiO2 from 358 ± 82 to 471 ± 106 mmHg) within one hour of CPB in our patients. There were no differences in PaO2/FiO2, respiratory mechanics and haemodynamics between the sevoflurane and propofol groups. CONCLUSIONS: In patients undergoing cardiac valve replacement with CPB, lung injury was mild, and sevoflurane- and propofol-based anaesthetic regimens showed similar effect on oxygenation, respiratory mechanics and haemodynamics during the early stage of CPB.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Ponte Cardiopulmonar , Implante de Prótese de Valva Cardíaca , Valvas Cardíacas/cirurgia , Pulmão/efeitos dos fármacos , Oxigênio/sangue , Propofol/administração & dosagem , Mecânica Respiratória/efeitos dos fármacos , Sevoflurano/administração & dosagem , Adulto , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , China , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica/efeitos dos fármacos , Humanos , Pulmão/fisiopatologia , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Propofol/efeitos adversos , Estudos Prospectivos , Sevoflurano/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
17.
J Pharm Pract ; 33(1): 102-107, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30157697

RESUMO

PURPOSE: A case of succinylcholine (SCh) and sevoflurane as a probable cause of rhabdomyolysis in an adult is presented, along with a review of the relevant literature and strategies for prevention. SUMMARY: A nondiabetic, morbidly obese 32-year-old female developed rhabdomyolysis after administration of SCh and sevoflurane for diagnostic procedures of 30 minutes' duration. Thirty-three hours following anesthesia, the patient developed diffuse muscle tenderness and progressive weakness with a creatinine kinase (CK) of 4319 U/L. Urinalysis findings indicated contamination, a white blood cells of 12.1 × 103/µL was stress induced, while all other labs were normal. Following 26 hours of intravenous fluids, the patient's CK decreased to 1243 U/L, with pain responsive to acetaminophen and improved mobility, resulting in discharge. With a lack of reasonable alternative causes and a temporal association of symptoms, procedural medication-induced rhabdomyolysis was suspected. Based on Naranjo scale evaluation, SCh and sevoflurane were probable causes of rhabdomyolysis. We reviewed the literature for SCh-induced rhabdomyolysis among adults and found 10 cases. The majority of patients received halogenated anesthesia (HA) and prophylaxis for SCh myopathy, with no known personal or family history of neuromuscular disorders (NMD) reported. CONCLUSION: Rhabdomyolysis was observed in a woman following the administration of SCh and sevoflurane for diagnostic procedures lasting 30 minutes. While avoidance is possible in adults with histories of NMDs, a high index of suspicion for occurrence of rhabdomyolysis is needed whenever combining SCh with HA in all adults.


Assuntos
Anestesia/efeitos adversos , Fármacos Neuromusculares Despolarizantes/efeitos adversos , Rabdomiólise/induzido quimicamente , Succinilcolina/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Doenças Neuromusculares , Rabdomiólise/etiologia , Sevoflurano/administração & dosagem , Sevoflurano/efeitos adversos , Succinilcolina/administração & dosagem
18.
Anesth Analg ; 130(6): e161-e164, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31453873

RESUMO

Seizures and interictal epileptiform discharges (IEDs) have been described during sevoflurane. We prospectively estimated their incidence in 54 otherwise neurologically healthy infants by obtaining the full-head video electroencephalogram (EEG). No infants had clinical seizures, but 1 had an electrographic seizure; 3 others had focal IEDs (7.4%; 95% confidence interval [CI], 2.1%-17.9%). We detected no differences in demographic or clinical characteristics between normal and abnormal EEG groups. Diffuse slowing was the most common initial EEG change followed by fast (α, ß) activity in all head leads. Larger studies with more statistical power are needed to further investigate the hypotheses generated with this research.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Ondas Encefálicas/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Eletroencefalografia , Movimento/efeitos dos fármacos , Sevoflurano/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Encéfalo/fisiopatologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Convulsões/induzido quimicamente , Convulsões/diagnóstico , Convulsões/fisiopatologia , Sevoflurano/efeitos adversos , Fatores de Tempo , Gravação em Vídeo
19.
Anesth Analg ; 130(2): 360-366, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30882520

RESUMO

BACKGROUND: We previously reported that the duration of hospitalization was not different between isoflurane and sevoflurane. But more plausible consequences of using soluble volatile anesthetics are delayed emergence from anesthesia and prolonged stays in the postanesthesia care unit (PACU). We therefore compared isoflurane and sevoflurane on emergence time and PACU duration. METHODS: We reanalyzed data from 1498 adults who participated in a previous alternating intervention trial comparing isoflurane and sevoflurane. Patients, mostly having colorectal surgery, were assigned to either volatile anesthetic in 2-week blocks that alternated for half a year. Emergence time was defined as the time from minimum alveolar concentration fraction reaching 0.3 at the end of the procedure until patients left the operating room. PACU duration was defined from admission to the end of phase 1 recovery. Treatment effect was assessed using Cox proportional hazards regression, adjusted for imbalanced baseline variables. RESULTS: A total of 674 patients were given isoflurane, and 824 sevoflurane. Emergence time was slightly longer for isoflurane with a median (quartiles) of 16 minutes (12-22 minutes) vs 14 minutes (11-19 minutes) for sevoflurane, with an adjusted hazard ratio of 0.81 (97.5% CI, 0.71-0.92; P < .001). Duration in the PACU did not differ, with a median (quartiles) of 2.6 hours (2.0-3.6 hours) for isoflurane and 2.6 hours (2.0-3.7 hours) hours for sevoflurane. The adjusted hazard ratio for PACU discharge time was 1.04 (97.5% CI, 0.91-1.18; P = .56). CONCLUSIONS: Isoflurane prolonged emergence by only 2 minutes, which is not a clinically important amount, and did not prolong length of stay in the PACU. The more soluble and much less-expensive anesthetic isoflurane thus seems to be a reasonable alternative to sevoflurane.


Assuntos
Período de Recuperação da Anestesia , Anestésicos Inalatórios/administração & dosagem , Isoflurano/administração & dosagem , Tempo de Internação/tendências , Cuidados Pós-Operatórios/tendências , Sevoflurano/administração & dosagem , Adulto , Idoso , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Isoflurano/efeitos adversos , Masculino , Pessoa de Meia-Idade , Sevoflurano/efeitos adversos , Fatores de Tempo
20.
Perfusion ; 35(1): 48-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31151363

RESUMO

INTRODUCTION: The increase of the anti-inflammatory CD163highHLA-DRlow blood monocyte subset is one of the mechanisms dampening inflammation during cardiac surgery with cardiopulmonary bypass. We evaluated the effect of two different anesthetic protocols, intravenous Propofol infusion or Sevoflurane-gas administration, on the perioperative frequency of this subset. METHODS: Blood from patients (Propofol = 11, Sevoflurane = 13) undergoing minimally invasive mitral valve surgery was drawn preoperatively (T1), before declamping (T2), at 6 (T3), 24 (T4), 48 (T5), and 72 hours (T6) after declamping. C-reactive protein, haptoglobin, and lactate dehydrogenase were measured. A hemolytic index, as C-reactive protein/haptoglobin ratio, was introduced. Monocyte expression of HLA-DR, CD163, and the CD163highHLA-DRlow subset fraction was quantified by flow cytometry. Baseline-referred variations of plasmatic and cellular data at T2 were normalized for clamping times. Subsequent time-point variations were normalized for the final cardiopulmonary bypass times. RESULTS: Variations of hemolytic index and lactate dehydrogenase were higher with Propofol at T3 (p = 0.004 and p = 0.02, respectively) when compared with Sevoflurane. At T2, the down-modulation of CD163 was higher with Propofol (p = 0.005). Starting from T3, the up-regulatory trend of CD163 was basically higher with Propofol, although not significantly. Propofol induced higher increments of HLA-DR low fractions, at T2 (p = 0.04) and, to a lesser extent, at T4 (p = 0.06). Starting from T3, the CD163highHLA-DRlow subset variations were higher with Propofol, especially at T4 and T6. CONCLUSION: Propofol seems to induce a higher postoperative fraction of the CD163highHLA-DRlow monocyte subset. This could represent either a compensatory mechanism dampening the higher inflammatory condition observed with Propofol at T2 or a consequence of a higher postoperative Propofol-induced hemolysis.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Citometria de Fluxo , Antígenos HLA-DR/sangue , Monócitos/efeitos dos fármacos , Propofol/administração & dosagem , Receptores de Superfície Celular/sangue , Sevoflurano/administração & dosagem , Idoso , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Biomarcadores/sangue , Feminino , Hemólise/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Monócitos/imunologia , Projetos Piloto , Propofol/efeitos adversos , Estudos Prospectivos , Distribuição Aleatória , Sevoflurano/efeitos adversos , Fatores de Tempo
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