Pharmacological preconditioning protects from ischemia/reperfusion-induced apoptosis by modulating Bcl-xL expression through a ROS-dependent mechanism.

Myocardial ischemia/reperfusion (I/R) injury is a frequent perioperative threat, with numerous strategies developed to limit and/or prevent it. One interesting axis of research is the anesthetic preconditioning (APc) agent's hypothesis (such as sevoflurane, SEV). However, APc's mode of action is still poorly understood and volatile anesthetics used as preconditioning agents are often not well suited in clinical practice. Here, in vitro using H9C2 cells lines (in myeloblast state or differentiated toward cardiomyocytes) and in vivo in mice, we identified that SEV-induced APc is mediated by a mild induction of reactive oxygen species (ROS) that activates Akt and induces the expression of the anti-apoptotic protein B-cell lymphoma-extra large (Bcl-xL), therefore protecting cardiomyocytes from I/R-induced death. Furthermore, we extended these results to human cardiomyocytes (derived from induced pluripotent stem - IPS - cells). Importantly, we demonstrated that this protective signaling pathway induced by SEV could be stimulated using the antidiabetic agent metformin (MET), suggesting the preconditioning properties of MET. Altogether, our study identified a signaling pathway allowing APc of cardiac injuries as well as a rational for the use of MET as a pharmacological preconditioning agent to prevent I/R injuries.

Anaesthetic practices for scheduled caesarean delivery: a 2005 French national survey.

BACKGROUND AND OBJECTIVE: It is not known whether anaesthetic practices for ASA I parturients undergoing scheduled caesarean delivery have changed since the last (1996) survey and how practices reflect current recommendations. METHODS: A 26-item survey questionnaire (organization of the maternity unit, preoperative evaluation, technical aspects describing regional or general anaesthesia, oxytocic and antibiotic drugs, postoperative analgesia) was distributed to all French obstetric units (excluding overseas). RESULTS: The response rate was 73% (451/621). Preoperative evaluation included a recent platelet count in 97% of responding units, and information was given to patients in 84% of cases. Antibiotic prophylaxis in accordance with French guidelines was used in 78% of units. Anaesthetic techniques were single-shot spinal, epidural, combined spinal epidural and general anaesthesia in decreasing order (92.5, 4.5, 2 and 1%, respectively). Effervescent cimetidine was the first choice in 62% of units. Cricoid pressure and succinylcholine were routinely used in 66 and 77% of units, respectively. Oxytocin was used appropriately in 65% of units. In addition to spinal or epidural opioids, paracetamol, NSAIDs and nefopam were added postoperatively in 98, 68 and 19% of units, respectively. Poorer practices were found in units having a lower annual delivery rate. CONCLUSIONS: Overall practice was in accordance with national guidelines or practice patterns defined by the expert committee. Regional anaesthesia and postoperative analgesia-related techniques particularly were adequate. Some deficits were of limited importance (antibiotic prophylaxis and oxytocin administration), whereas others (use of succinylcholine and cricoid pressure) remain of concern.

[The importance of nutritional support for head injured patients]. / Le support nutrionnel en traumatologie cranienne EST-IL facultatif ou obligatoire?

Serious head injuries lead to any metabolic disorders such as, in particular a protein types cataolism and immunodepression. Early nutritional support for the patient in this case is definitely beneficial. It should be started as soon as the patient is out of danger. Enteral feeding should be preferred to parenteral feeding. In case of disorder of the bavel habit or of malabsorption, parenteral protein-energy intake should be prescribed for a short period. In case of neuroagression, a suppementary intake of amino-acids (glutamine, arginine) seems beneficial for a betten immuniy defence system.