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An J, Kim E, Lee J, Kim H, Son J, Huh J, Woo K. Comparison of sugammadex and pyridostigmine bromide for reversal of rocuronium-induced neuromuscular blockade in short-term pediatric surgery: a prospective randomized study. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jihyun An
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Eunju Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jihyang Lee
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyun Kim
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jongcheol Son
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Joonyoung Huh
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Kyeongyoon Woo
- Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea
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Development of wirelessly-powered, extracranial brain activator (ECBA) in a large animal model for the future non-invasive human neuromodulation. Sci Rep 2019; 9:10906. [PMID: 31358822 PMCID: PMC6662771 DOI: 10.1038/s41598-019-47383-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/16/2019] [Indexed: 01/08/2023] Open
Abstract
As transcranial electrical stimulation (tES) is an emerging and promising technique for neuromodulation, we developed a novel device; wirelessly-powered, extracranial brain activator (ECBA), which is mounted subcutaneously, and its neuromodulation effect was investigated. The oscillatory changes in electrocorticography (EcoG) were analyzed from two types of stimulation. Two weeks prior to the recording experiment, we underwent surgery for implantation of subdural strips and ECBA module over centroparietal regions of anesthetized beagles. Low-frequency stimulation (LFS) and subsequent high-frequency stimulation (HFS) protocols (600 pulses respectively) were applied. Then, the power changes before and after each stimulation in five different bands were compared. A significantly larger voltage difference with subcutaneous than transcutaneous stimulation measured at EcoG channels indicated a substantial current attenuation between the skin and skull. Compared with the baseline, all subjects showed consistently decreased delta power and increased gamma power after HFS. LFS also induced a similar, but opposite, pattern of power change in four beagles. The results from this study indicate that LFS and HFS with our novel ECBA can consistently and effectively modulate neural activity of the cortex, inducing neural inhibition and facilitation functions, respectively. Future studies are necessary to further ensuring a consistent efficacy and long-term safety.
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Influence of midazolam premedication on intraoperative EEG signatures in elderly patients. Clin Neurophysiol 2019; 130:1673-1681. [PMID: 31351371 DOI: 10.1016/j.clinph.2019.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/23/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the influence of midazolam premedication on the EEG-spectrum before and during general anesthesia in elderly patients. METHODS Patients aged ≥65 years, undergoing elective surgery were included in this prospective observational study. A continuous pre- and intraoperative frontal EEG was recorded in patients who received premedication with midazolam (Mid, n = 15) and patients who did not (noMid, n = 30). Absolute power within the delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), and beta (12-25 Hz) frequency-bands was analyzed in EEG-sections before (pre-induction), and after induction of anesthesia with propofol (post-induction), as well as during general anesthesia with either propofol or volatile-anesthetics (intra-operative). RESULTS Pre-induction, α-power of Mid patients was lower compared with noMid-patients (α-power: Mid: -10.75 dB vs. noMid: -9.20 dB; p = 0.036). After induction of anesthesia Mid-patients displayed a stronger increase of frontal α-power resulting in higher absolute α-power at post-induction state, (α-power: Mid -3.56 dB vs. noMid: -6.69 dB; p = 0.004), which remained higher intraoperatively (α-power: Mid: -2.12 dB vs. noMid: -6.10 dB; p = 0.024). CONCLUSION Midazolam premedication alters the intraoperative EEG-spectrum in elderly patients. SIGNIFICANCE This finding provides further evidence for the role of GABAergic activation in the induction of elevated, frontal α-power during general anesthesia. TRIAL REGISTRY NUMBER NCT02265263. 23 September 2014. Principal investigator: Prof. Dr. med. Claudia Spies. (https://clinicaltrials.gov/ct2/show/NCT02265263).
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Liou JY, Wang HY, Tsou MY, Chang WK, Kuo IT, Ting CK. Opioid and propofol pharmacodynamics modeling during brain mapping in awake craniotomy. J Chin Med Assoc 2019; 82:390-395. [PMID: 30893252 DOI: 10.1097/jcma.0000000000000092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Awake craniotomy (AC) is performed to identify cerebral language center. The challenge of anesthesia is to maintain a calm, comfortable, and cooperative patient during the mapping phase. Response surface models (RSMs) are multidrug modeling algorithms. In this pharmacodynamic study, we investigate the first use of RSM with bispectral index (BIS) to predict patient's response to name calling (RNC) and wakefulness (complete neurological tests) during AC. METHODS The study is performed in two phases. We prospectively enrolled 40 patients who received video-assisted thoracoscopic surgery (VATS) using propofol and fentanyl as the modeling group. Effect-site concentrations (Ce) and BIS values were recorded and a RSM is built from the data set. We verified the RSM retrospectively in AC patients, designated as the validation group. Corresponding BIS values were analyzed for RNC and wakefulness. RESULTS A total of 155 data sets of propofol Ce, fentanyl Ce, and BIS pairs were available for modeling. The range of propofol and fentanyl Ce were 0 to 9.95 μg/mL and 0 to 3.69 ng/mL, respectively. Observed BIS ranged from 21 to 98. The model identified an additive interaction between propofol and an opioid. RNC at BIS 64 is predicted by the model and 70 is required for wakefulness. CONCLUSION RSM built from VATS patients is verified with a separate group of AC patient. The BIS target advised for RSM-predicted wakefulness is 70. The model illustrates the timeline to wakefulness during AC under propofol and an opioid. It has implications in guiding, dosing, and estimation of time to wakefulness with propofol and an opioid.
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Affiliation(s)
- Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsin-Yi Wang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Translational and Interdisciplinary Medicine & Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan, ROC
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, ROC
| | - I-Ting Kuo
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Egan TD. Are opioids indispensable for general anaesthesia? Br J Anaesth 2019; 122:e127-e135. [PMID: 31104756 DOI: 10.1016/j.bja.2019.02.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/22/2019] [Indexed: 01/06/2023] Open
Abstract
The drug-induced, reversible coma of anaesthesia requires three clinical outcomes: unconsciousness, immobility, and the control of autonomic nervous system (ANS) responses to surgical stimulation. Producing the anaesthetised state with a single anaesthetic agent, such as an inhaled vapour or propofol, is challenging, primarily because suppressing ANS responses requires very high anaesthetic concentrations, resulting in haemodynamic depression and prolonged recovery. The antinociceptive effects of opioids (i.e. minimum alveolar concentration reduction) are thus central to the well-entrenched 'balanced anaesthesia' concept. In recent years, the notion of 'multimodal general anaesthesia' has extended the concept of balanced anaesthesia to include more drugs that target different neuroanatomical circuits and multiple neurophysiologic mechanisms. The opioid epidemic has provided some of the motivation to move away from opioids toward other adjunct drugs. Persistent opioid use after surgery is a component of the opioid epidemic and is a major concern for perioperative physicians. Potential solutions to the problem of persistent opioid use after surgery have focused on proper 'opioid stewardship' after operation, wherein opioids are used conservatively in combination with other analgesic adjuncts, and excessive opioid prescribing for home use is avoided. But there is a paucity of data on how intraoperative opioid usage patterns may be contributing to persistent opioid use after surgery. There are cogent reasons to moderate perioperative opioid use, including intraoperative opioids, but whether these changes in practice integral to the multimodal general anaesthesia concept will improve anaesthesia outcomes, including persistent opioid use after surgery, is unknown. Studies investigating these issues are an important research priority.
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Affiliation(s)
- Talmage D Egan
- Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Weber F, Prasser C. Investigating propofol-sufentanil interaction using clinical endpoints and processed electroencephalography: a prospective randomized controlled trial. Minerva Anestesiol 2019; 85:271-278. [DOI: 10.23736/s0375-9393.18.12326-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bradley MP, Doerning CM, Nowland MH, Lester PA. Intramuscular Administration of Alfaxalone Alone and in Combination for Sedation and Anesthesia of Rabbits ( Oryctolagus cuniculus). JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2019; 58:216-222. [PMID: 30819274 DOI: 10.30802/aalas-jaalas-18-000078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study compared alfaxalone, alone and in combination with other medications, for sedative and anesthetic properties after intramuscular administration in New Zealand white rabbits. In the main portion of the study, 6 female rabbits were assigned to 5 treatment regimens in a blinded crossover design. Alfaxalone (6 mg/kg IM) was administered alone and in combination with each of the following: 0.3 mg/kg butorphanol; 1 mg/kg midazolam; 0.2 mg/kg dexmedetomidine; and both 0.3 mg/kg butorphanol and 0.2 mg/kg dexmedetomidine. An additional 6 rabbits received 0.2 mg/kg dexmedetomidine for comparison. The median time to onset of recumbency ranged from 2.0 to 5.5 min, with times significantly shorter for animals that received alfaxalone with either midazolam or dexmedetomidine than for those given dexmedetomidine only. Duration of sedation (mean ± 1 SD) was: alfaxalone only, 40 ± 7.3 min; alfaxalone with butorphanol, 47.8 ± 9.9 min; alfaxalone with midazolam, 65.2 ± 6.5 min; alfaxalone with dexmedetomidine, 157.5 ± 22.4 min; alfaxalone with butorphanol and dexmedetomidine, 157.7 ± 22.3 min, and dexmedetomidine only, 93.7 ± 11.9 min. Response to noxious stimuli was absent in 2 of the rabbits given dexmedetomidine only, 4 of those given alfaxalone with dexmedetomidine, and all 6 of the animals dosed with alfaxalone, butorphanol, and dexmedetomidine; this last group displayed the longest absence of a toe-pinch response (57 ± 3 min).
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Affiliation(s)
- Michael P Bradley
- Unit for Laboratory Animal Medicine; University of Michigan, Ann Arbor, Michigan, USA.
| | - Carolyn M Doerning
- Unit for Laboratory Animal Medicine; University of Michigan, Ann Arbor, Michigan, USA
| | - Megan H Nowland
- Unit for Laboratory Animal Medicine; University of Michigan, Ann Arbor, Michigan, USA
| | - Patrick A Lester
- Unit for Laboratory Animal Medicine; University of Michigan, Ann Arbor, Michigan, USA
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58
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van den Berg JP, Vereecke HEM, Proost JH, Eleveld DJ, Wietasch JKG, Absalom AR, Struys MMRF. Pharmacokinetic and pharmacodynamic interactions in anaesthesia. A review of current knowledge and how it can be used to optimize anaesthetic drug administration. Br J Anaesth 2018; 118:44-57. [PMID: 28039241 DOI: 10.1093/bja/aew312] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
This review describes the basics of pharmacokinetic and pharmacodynamic drug interactions and methodological points of particular interest when designing drug interaction studies. It also provides an overview of the available literature concerning interactions, with emphasis on graphic representation of interactions using isoboles and response surface models. It gives examples on how to transform this knowledge into clinically and educationally applicable (bedside) tools.
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Affiliation(s)
- J P van den Berg
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H E M Vereecke
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J H Proost
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D J Eleveld
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J K G Wietasch
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A R Absalom
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M M R F Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD. Guidelines for the safe practice of total intravenous anaesthesia (TIVA). Anaesthesia 2018; 74:211-224. [DOI: 10.1111/anae.14428] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2018] [Indexed: 12/16/2022]
Affiliation(s)
- A. F. Nimmo
- Department of Anaesthesia; Royal Infirmary of Edinburgh; Edinburgh UK; Society for Intravenous Anaesthesia (Co-Chair of the Working party)
| | - A. R. Absalom
- Department of Anesthesiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands: Society for Intravenous Anaesthesia
| | - O. Bagshaw
- Department of Anaesthesia; Birmingham Women's and Children's NHS Foundation Trust; Birmingham UK; Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - A. Biswas
- Adult/Obstetric Anesthesiology; Sidra Medicine; Qatar Foundation; Doha Qatar; Society for Intravenous Anaesthesia
| | - T. M. Cook
- Department of Anaesthesia and Intensive Care Medicine; Royal United Hospital NHS Foundation Trust; Bath UK; Royal College of Anaesthetists
| | - A. Costello
- Department of Anaesthesia; Milton Keynes University Hospital NHS Foundation Trust; UK; Association of
Anaesthetists Trainee Committee
| | - S. Grimes
- Department of Anaesthesia; Mid Western Regional Hospital; Limerick Ireland; College of
Anaesthesiologists of Ireland
| | - D. Mulvey
- Department of Anaesthesia; Derby Teaching Hospitals NHS Foundation Trust; Derby UK; Society for Intravenous Anaesthesia
| | - S. Shinde
- Department of Anaesthesia; North Bristol NHS Trust; Bristol UK; Association of Anaesthetists (Co-Chair of the Working Party)
| | - T. Whitehouse
- Department of Anaesthesia and Critical Care; University Hospitals Birmingham NHS Foundation Trust; Birmingham UK; Intensive Care Society
| | - M. D. Wiles
- Department of Anaesthesia; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield UK; Editor, Anaesthesia
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61
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Shafiekhani M, Mirjalili M, Vazin A. Psychotropic drug therapy in patients in the intensive care unit - usage, adverse effects, and drug interactions: a review. Ther Clin Risk Manag 2018; 14:1799-1812. [PMID: 30319262 PMCID: PMC6168070 DOI: 10.2147/tcrm.s176079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Managing psychological problems in patients admitted to intensive care unit (ICU) is a big challenge, requiring pharmacological interventions. On the other hand, these patients are more prone to side effects and drug interactions associated with psychotropic drugs use. Benzodiazepines (BZDs), antidepressants, and antipsychotics are commonly used in critically ill patients. Therefore, their therapeutic effects and adverse events are discussed in this study. Different studies have shown that non-BZD drugs are preferred to BZDs for agitation and pain management, but antipsychotic agents are not recommended. Also, it is better not to start antidepressants until the patient has fully recovered. However, further investigations are required for the use of psychotropic drugs in ICUs.
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Affiliation(s)
- Mojtaba Shafiekhani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
| | - Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran,
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Abstract
Abstract
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
Xenon is an elemental anesthetic with nine stable isotopes. Nuclear spin is a quantum property which may differ among isotopes. Xenon 131 (131Xe) has nuclear spin of 3/2, xenon 129 (129Xe) a nuclear spin of 1/2, and the other seven isotopes have no nuclear spin. This study was aimed to explore the effect of nuclear spin on xenon anesthetic potency.
Methods
Eighty C57BL/6 male mice (7 weeks old) were randomly divided into four groups, xenon 132 (132Xe), xenon 134 (134Xe), 131Xe, and 129Xe groups. Due to xenon’s low potency, loss of righting reflex ED50 for mice to xenon was determined with 0.50% isoflurane. Loss of righting reflex ED50 of isoflurane was also measured, and the loss of righting reflex ED50 values of the four xenon isotopes were then calculated. The exact polarizabilities of the isotopes were calculated.
Results
Combined with 0.50% isoflurane, the loss of righting reflex ED50 values were 15 ± 4%, 16 ± 5%, 22 ± 5%, and 23 ± 7% for 132Xe, 134Xe, 131Xe, and 129Xe, respectively. For xenon alone, the loss of righting reflex ED50 values of 132Xe, 134Xe, 131Xe, and 129Xe were 70 ± 4%, 72 ± 5%, 99 ± 5%, and 105 ± 7%, respectively. Four isotopes had a same exact polarizability of 3.60 Å3.
Conclusions
Xenon isotopes with nuclear spin are less potent than those without, and polarizability cannot account for the difference. The lower anesthetic potency of 129Xe may be the result of it participating in conscious processing and therefore partially antagonizing its own anesthetic potency. Nuclear spin is a quantum property, and our results are consistent with theories that implicate quantum mechanisms in consciousness.
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Hutt A, Lefebvre J, Hight D, Sleigh J. Suppression of underlying neuronal fluctuations mediates EEG slowing during general anaesthesia. Neuroimage 2018; 179:414-428. [PMID: 29920378 DOI: 10.1016/j.neuroimage.2018.06.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/03/2018] [Accepted: 06/12/2018] [Indexed: 11/25/2022] Open
Abstract
The physiological mechanisms by which anaesthetic drugs modulate oscillatory brain activity remain poorly understood. Combining human data, mathematical and computational analysis of both spiking and mean-field models, we investigated the spectral dynamics of encephalographic (EEG) beta-alpha oscillations, observed in human patients undergoing general anaesthesia. The effect of anaesthetics can be modelled as a reduction of neural fluctuation intensity, and/or an increase in inhibitory synaptic gain in the thalamo-cortical circuit. Unlike previous work, which suggested the primary importance of gamma-amino-butryic-acid (GABA) augmentation in causing a shift to low EEG frequencies, our analysis demonstrates that a non-linear transition, triggered by a simple decrease in neural fluctuation intensity, is sufficient to explain the clinically-observed appearance - and subsequent slowing - of the beta-alpha narrowband EEG peak. In our model, increased synaptic inhibition alone, did not correlate with the clinically-observed encephalographic spectral changes, but did cause the anaesthetic-induced decrease in neuronal firing rate. Taken together, our results show that such a non-linear transition results in functional fragmentation of cortical and thalamic populations; highly correlated intra-population dynamics triggered by anaesthesia decouple and isolate neural populations. Our results are able to parsimoniously unify and replicate the observed anaesthetic effects on both the EEG spectra and inter-regional connectivity, and further highlight the importance of neural activity fluctuations in the genesis of altered brain states.
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Affiliation(s)
- Axel Hutt
- Department FE 12 - Data Assimilation, Deutscher Wetterdienst, 63067, Offenbach am Main, Germany; Department of Mathematics and Statistics, University of Reading, Reading, RG6 6AX, UK.
| | - Jérémie Lefebvre
- Krembil Research Institute, University Health Network, Toronto, Ontario, M5T 2S8, Canada; Department of Mathematics, University of Toronto, Toronto, Ontario, M5T 2S8, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, M5T 2S8, Canada
| | - Darren Hight
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, 3240, New Zealand; Department of Anaesthesiology and Pain Therapy, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Jamie Sleigh
- Department of Anaesthesiology, Waikato Clinical Campus, University of Auckland, Hamilton, 3240, New Zealand.
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Lee YJ, Kim M, Lee JY, Jung SH, Jeon HY, Lee SA, Kang S, Han ET, Park WS, Hong SH, Kim YM, Ha KS. The benzodiazepine anesthetic midazolam prevents hyperglycemia-induced microvascular leakage in the retinas of diabetic mice. FASEB J 2018; 32:fj201800014RR. [PMID: 29782207 DOI: 10.1096/fj.201800014rr] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We investigated the beneficial effects of midazolam against vascular endothelial growth factor (VEGF)-induced vascular leakage and its molecular mechanism of action in human retinal endothelial cells (HRECs) and the retinas of diabetic mice. Midazolam inhibited VEGF-induced elevation of intracellular Ca2+, generation of reactive oxygen species (ROS), and transglutaminase activation in HRECs; these effects were reversed by the GABA, type A (GABAA) receptor antagonist flumazenil but not by the translocator protein antagonist PK11195. Midazolam also prevented VEGF-induced disassembly of adherens junctions and in vitro permeability. Intravitreal injection of midazolam prevented hyperglycemia-induced ROS generation, transglutaminase activation, and subsequent vascular leakage in the retinas of diabetic mice, and those effects were reversed by flumazenil. The roles of flumazenil were further supported by identifying GABAA receptors in mouse retinas. Thus, midazolam prevents hyperglycemia-induced vascular leakage by inhibiting VEGF-induced intracellular events in the retinas of diabetic mice.-Lee, Y.-J., Kim, M., Lee, J.-Y., Jung, S.-H., Jeon, H.-Y., Lee, S.-A., Kang, S., Han, E.-T., Park, W. S., Hong, S.-H., Kim, Y.-M., Ha, K.-S. The benzodiazepine anesthetic midazolam prevents hyperglycemia-induced microvascular leakage in the retinas of diabetic mice.
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Affiliation(s)
- Yeon-Ju Lee
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Minsoo Kim
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Anesthesiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jee-Yeon Lee
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Se-Hui Jung
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Hye-Yoon Jeon
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seung Ah Lee
- Department of Anesthesiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seongsik Kang
- Department of Anesthesiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun-Taek Han
- Department of Medical Environmental Biology and Tropical Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine, Chuncheon, Korea; and
| | - Seok-Ho Hong
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Young-Myeong Kim
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kwon-Soo Ha
- Department of Molecular and Cellular Biochemistry, Kangwon National University School of Medicine, Chuncheon, Korea
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Dexmedetomidine as an adjuvant during general anesthesia. J Anesth 2018; 32:313-315. [PMID: 29766277 DOI: 10.1007/s00540-018-2509-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/12/2018] [Indexed: 10/16/2022]
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66
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Semi-adaptive switching control for infusion of two interacting medications. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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67
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Euthanasia of Cattle: Practical Considerations and Application. Animals (Basel) 2018; 8:ani8040057. [PMID: 29673140 PMCID: PMC5946141 DOI: 10.3390/ani8040057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Methods recognized as acceptable for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The most common injectable anesthetic agent used for euthanasia is pentobarbital and while it may be the preferred method for euthanasia in sensitive situations, it creates significant challenges for disposal of animal remains. Gunshot and captive bolt are the more common methods used on farms and ranches because they are inexpensive, humane and do not complicate carcass disposal. Firearms must be of the proper caliber and loaded with the proper ammunition. Captive bolt, equipped with a penetrating bolt, is to be used on adult animals, whereas the non-penetrating (mushroom head) bolt should be reserved for use in calves (three months of age or less). In addition to selection of the proper firearm or captive bolt, successful euthanasia requires use of the proper anatomic site and adjunctive steps to assure death. The indicators of unconsciousness and death must be clearly understood and confirmed in all situations involving euthanasia. Tools for the efficient depopulation of a large feedlot, dairy or beef cattle operation as may be required in a national animal health emergency situation have been developed and validated as effective. Finally, the human impact of euthanasia cannot be underestimated. Symptoms of mental illness including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals. Abstract Acceptable methods for the euthanasia of cattle include overdose of an anesthetic, gunshot and captive bolt. The use of anesthetics for euthanasia is costly and complicates carcass disposal. These issues can be avoided by use of a physical method such as gunshot or captive bolt; however, each requires that certain conditions be met to assure an immediate loss of consciousness and death. For example, the caliber of firearm and type of bullet are important considerations when gunshot is used. When captive bolt is used, a penetrating captive bolt loaded with the appropriate powder charge and accompanied by a follow up (adjunctive) step to assure death are required. The success of physical methods also requires careful selection of the anatomic site for entry of a “free bullet” or “bolt” in the case of penetrating captive bolt. Disease eradication plans for animal health emergencies necessitate methods of euthanasia that will facilitate rapid and efficient depopulation of animals while preserving their welfare to the greatest extent possible. A portable pneumatic captive bolt device has been developed and validated as effective for use in mass depopulation scenarios. Finally, while most tend to focus on the technical aspects of euthanasia, it is extremely important that no one forget the human cost for those who may be required to perform the task of euthanasia on a regular basis. Symptoms including depression, grief, sleeplessness and destructive behaviors including alcoholism and drug abuse are not uncommon for those who participate in the euthanasia of animals.
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Reed R, Doherty T. Minimum alveolar concentration: Key concepts and a review of its pharmacological reduction in dogs. Part 2. Res Vet Sci 2018; 118:27-33. [PMID: 29421482 DOI: 10.1016/j.rvsc.2018.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To outline the major components of the minimum alveolar concentration (MAC) and review the literature regarding pharmacological manipulation of the MAC of halothane, isoflurane, sevoflurane, enflurane, and desflurane in dogs. The pharmacological agents included are alpha-2 agonists, benzodiazepines, propofol, opioids, lidocaine, acepromazine, non-steroidal anti-inflammatory agents (NSAIDs), maropitant, and NMDA antagonists. Part 2 of this review will focus on the effect of opioids, lidocaine, NSAIDs, maropitant, acepromazine, and NMDA antagonists on MAC. DATABASES USED PubMed, Google Scholar, CAB Abstracts. Search terms used: minimum alveolar concentration, MAC, dog, canine, inhaled anesthetic potency, isoflurane, sevoflurane, desflurane, enflurane, and halothane. CONCLUSIONS Opioids, lidocaine, NSAIDs, maropitant, acepromazine, and NMDA antagonists have been shown to reduce the MAC of inhaled anesthetics in dogs and allow for clinically important decreases in inhalant anesthetic use. Thus, the use of these agents potentially decrease the adverse cardiovascular and pulmonary effects associated with the use of high concentrations of inhaled anesthetics.
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Affiliation(s)
- Rachel Reed
- University of Georgia College of Veterinary Medicine, 2200 College Station Rd., Athens, GA 30605, USA.
| | - Thomas Doherty
- University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996, USA.
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Reed R, Doherty T. Minimum alveolar concentration: Key concepts and a review of its pharmacological reduction in dogs. Part 1. Res Vet Sci 2018; 117:266-270. [PMID: 29331922 DOI: 10.1016/j.rvsc.2018.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/25/2017] [Accepted: 01/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To outline the major components of the minimum alveolar concentration (MAC) and review the literature in regard to pharmacological manipulation of the MAC of halothane, isoflurane, sevoflurane, enflurane, and desflurane in dogs. The pharmacologic agents included are alpha-2 agonists, benzodiazepines, propofol, maropitant, opioids, lidocaine, acepromazine, non-steroidal anti-inflammatory agents, and NMDA antagonists. Part 1 will focus on summarizing the relevance, measurement, and mechanisms of MAC and review the effects of alpha-2 agonists, benzodiazepines, and propofol on MAC. DATABASES USED PubMed, Google Scholar, CAB Abstracts. Search terms used: minimum alveolar concentration, MAC, dog, canine, inhaled anesthetic potency, isoflurane, sevoflurane, desflurane, enflurane, and halothane. CONCLUSIONS Many drugs reduce the MAC of inhaled anesthetics in dogs, and allow for a clinically important decrease in inhalant anesthetic use. A decrease in MAC may decrease the adverse cardiovascular and pulmonary effects associated with the use of high concentrations of inhaled anesthetics.
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Affiliation(s)
- Rachel Reed
- University of Georgia College of Veterinary Medicine, 2200 College Station Rd., Athens, GA 30605, USA.
| | - Thomas Doherty
- University of Tennessee College of Veterinary Medicine, 2407 River Dr., Knoxville, TN 37996, USA.
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Bracco S, Asnaghi D, Negroni M, Sozzani P, Comotti A. Porous dipeptide crystals as volatile-drug vessels. Chem Commun (Camb) 2018; 54:148-151. [DOI: 10.1039/c7cc06534e] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Anesthetic vapors find temporary hospitality in porous dipeptide crystals, which behave as biologically friendly hosts and carriers.
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Affiliation(s)
- S. Bracco
- Department of Materials Science
- University of Milano Bicocca and INSTM Consortium
- Milano
- Italy
| | - D. Asnaghi
- Department of Materials Science
- University of Milano Bicocca and INSTM Consortium
- Milano
- Italy
| | - M. Negroni
- Department of Materials Science
- University of Milano Bicocca and INSTM Consortium
- Milano
- Italy
| | - P. Sozzani
- Department of Materials Science
- University of Milano Bicocca and INSTM Consortium
- Milano
- Italy
| | - A. Comotti
- Department of Materials Science
- University of Milano Bicocca and INSTM Consortium
- Milano
- Italy
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From pharmacokinetics to pharmacodynamics - Are we ready for 3D software?☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201710000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tafur-Betancourt LA, Lema FE, Milla GMDM, Londoño A, Vargas JRN. From pharmacokinetics to pharmacodynamics – Are we ready for 3D software? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tafur-Betancourt LA, Lema F. E, Milla G. MDM, Londoño A, Navarro Vargas JR. De la farmacocinética a la farmacodinámica, ¿estamos listos para los software 3D? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Allison A, Robinson R, Jolliffe C, Taylor PM. Evaluation of the use of midazolam as a co-induction agent with ketamine for anaesthesia in sedated ponies undergoing field castration. Equine Vet J 2017; 50:321-326. [PMID: 28898439 DOI: 10.1111/evj.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 09/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are limited investigations comparing ketamine to a ketamine-midazolam co-induction. OBJECTIVES To compare quality and safety of general anaesthesia induced using ketamine alone with anaesthesia co-induced using ketamine and midazolam. STUDY DESIGN Randomised, double blinded, placebo controlled trial. METHODS After i.v. detomidine (20 μg/kg) thirty-eight ponies undergoing field castration received either 0.06 mg/kg (0.6 mL/50 kg) midazolam (group M) or 0.6 mL/50 kg placebo (group P) with 2.2 mg/kg ketamine i.v. for anaesthetic induction. Quality of anaesthetic induction, endotracheal intubation, surgical relaxation and recovery were scored using combinations of simple descriptive and visual analogue scales. Time of sedation, induction, start of endotracheal intubation, first movement, sternal recumbency and standing were recorded, as were time, number and total quantity of additional i.v. detomidine and ketamine injections. Cardiorespiratory variables were assessed every 5 min. Adverse effects were documented. Data were tested for normality and analysed with a mixed model ANOVA, Fisher's exact test, unpaired Students' t test and Wilcoxon Rank-sum as appropriate; P<0.05 was considered significant. RESULTS Group M had better scores for induction (P = 0.005), intubation (P<0.001) and surgical relaxation (P<0.001) and required fewer additional injections of detomidine and ketamine (P = 0.04). Time (minutes) from induction to first movement (P<0.001), sternal recumbency (P =< 0.001) and standing was longer (P = 0.05) in group M. Recoveries were uneventful with no difference in quality between groups (P = 0.78). MAIN LIMITATIONS Clinical study with noninvasive monitoring undertaken in field conditions. CONCLUSIONS Ketamine-midazolam co-induction compared to ketamine alone improved quality of induction, ease of intubation and muscle relaxation without impacting recovery quality.
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Affiliation(s)
- A Allison
- Animal Health Trust, Newmarket, Suffolk, UK
| | - R Robinson
- Animal Health Trust, Newmarket, Suffolk, UK
| | - C Jolliffe
- Animal Health Trust, Newmarket, Suffolk, UK
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Bhavsar R, Ryhammer PK, Greisen J, Jakobsen CJ. Lower Dose of Sufentanil Does Not Enhance Fast Track Significantly-A Randomized Study. J Cardiothorac Vasc Anesth 2017; 32:731-738. [PMID: 29128486 DOI: 10.1053/j.jvca.2017.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Adjustment in the doses of opioids has been a focus of interest for achieving better fast-track conditions in cardiac anesthesia, but relatively sparse information exists on the potential effect of psychologic and behavioral factors, such as stress, anxiety, and type of personality, on anesthesia requirements and patient turnover in the cardiac recovery unit (CRU); to the authors' knowledge, this particular focus has not been systematically investigated. In this randomized study, the authors tested the hypothesis that low-dose sufentanil, compared with a standard dose, can improve fast-track parameters and the overall quality of recovery. Opioid requirements related to personality type, pain sensitivity, and preoperative stress and anxiety also were assessed. DESIGN A randomized, prospective study. PARTICIPANTS The study comprised 60 patients scheduled for elective coronary artery bypass grafting with or without aortic valve replacement. SETTING A university hospital. INTERVENTIONS Patients were randomly assigned to receive either a standard dose (bolus 0.5 µg/kg) or low dose (bolus 0.25 µg/kg) of sufentanil combined with propofol. MEASUREMENTS AND MAIN RESULTS The primary outcome variables were ventilation time and eligible time to discharge from the CRU. The secondary objective was to evaluate the relationship between opioid requirements and personality type, pain sensitivity, and preoperative stress and anxiety. The groups were comparable in selected demographics and perioperative parameters. There was no difference between groups in ventilation time (low dose: 191 [163-257] v standard dose: 205 [139-279] min; p = 0.405); eligible CRU discharge time (10.3 ± 5.0 v 10.3 ± 4.2 h; p = 0.978); or administration of postoperative morphine (25 [11-34) v 27 [10-39] g; p = 0.790). There was no difference between groups in total sufentanil administration and various preoperative psychologic and behavioral test levels nor in the time to reach bispectral index <50 during induction, except that personality type A demonstrated a longer induction time of 10 (8-12) minutes versus 6 (4-8) minutes in low-score patients. CONCLUSION A lower dose of sufentanil, compared with a standard dose, does not enhance fast-track conditions significantly.
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Affiliation(s)
- Rajesh Bhavsar
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Pia Katarina Ryhammer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Greisen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Carl-Johan Jakobsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
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Shin DJ, Germann AL, Steinbach JH, Akk G. The Actions of Drug Combinations on the GABA A Receptor Manifest as Curvilinear Isoboles of Additivity. Mol Pharmacol 2017; 92:556-563. [PMID: 28790148 DOI: 10.1124/mol.117.109595] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/07/2017] [Indexed: 02/04/2023] Open
Abstract
Drug interactions are often analyzed in terms of isobolograms. In the isobologram, the line connecting the axial points corresponding to the concentrations of two different drugs that produce an effect of the same magnitude is termed an isobole of additivity. Although the isobole of additivity can be a straight line in some special cases, previous work has proposed that it is curvilinear when the two drugs differ in their maximal effects or Hill slopes. Modulators of transmitter-gated ion channels have a wide range of maximal effects as well as Hill slopes, suggesting that the isoboles for drug actions on ion channel function are not linear. In this study, we have conducted an analysis of direct activation and potentiation of the human α1β2γ2L GABAA receptor to demonstrate that: 1) curvilinear isoboles of additivity are predicted by a concerted transition model where the binding of each GABAergic drug additively and independently reduces the free energy of the open receptor compared with the closed receptor; and 2) experimental data for receptor activation using the agonist pair of GABA and propofol or potentiation of responses to a low concentration of GABA by the drug pair of alfaxalone and propofol agree very well with predictions. The approach assuming independent energetic contributions from GABAergic drugs enables, at least for the drug combinations tested, a straightforward method to accurately predict functional responses to any combination of concentrations.
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Affiliation(s)
- Daniel J Shin
- Department of Anesthesiology (D.J.S., A.L.G., J.H.S., G.A.), and the Taylor Family Institute for Innovative Psychiatric Research (J.H.S., G.A.), Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Allison L Germann
- Department of Anesthesiology (D.J.S., A.L.G., J.H.S., G.A.), and the Taylor Family Institute for Innovative Psychiatric Research (J.H.S., G.A.), Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joe Henry Steinbach
- Department of Anesthesiology (D.J.S., A.L.G., J.H.S., G.A.), and the Taylor Family Institute for Innovative Psychiatric Research (J.H.S., G.A.), Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gustav Akk
- Department of Anesthesiology (D.J.S., A.L.G., J.H.S., G.A.), and the Taylor Family Institute for Innovative Psychiatric Research (J.H.S., G.A.), Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Stevic M, Ristic N, Budic I, Ladjevic N, Trifunovic B, Rakic I, Majstorovic M, Burazor I, Simic D. Comparison of ketamine and ketofol for deep sedation and analgesia in children undergoing laser procedure. Lasers Med Sci 2017; 32:1525-1533. [DOI: 10.1007/s10103-017-2275-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
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The hidden world of drug interactions in anesthesia☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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79
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The hidden world of drug interactions in anesthesia. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kim JD, Kim JW, Kung HC, Kang JH, Shin HY, Kim DS, Ryu SJ, Kim KH. Hemodynamic Effects of Co-administration of Midazolam during Anesthesia Induction with Propofol and Remifentanil in Hypertensive Patients. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives Propofol, midazolam and remifentanil are commonly used for clinical anesthesia. We compared the effects of midazolam-propofol-remifentanil and propofol-remifentanil on hemodynamic responses during anesthesia induction in hypertensive patients. Methods Seventy-six hypertensive patients with ASA II-III were assigned to receive midazolam-propofol (group MP; n = 38) or propofol (group P; n = 38). Anesthesia was induced with midazolam 0.03 mg/kg (group MP) or saline 0.03 ml/kg (group P). After two minutes, propofol 1.0 mg/kg (group MP) or 1.5 mg/kg (group P) i.v. bolus was administered. Simultaneously, 4 ng/ml of remifentanil target controlled infusion (TCI) was administered in both groups. Anesthesia was maintained using sevoflurane and 2 ng/ml of remifentanil TCI. Systolic, diastolic, and mean blood pressure (SBP, DBP, and MBP) and heart rate (HR) were measured before induction, 2 min after midazolam or normal saline, 2 min after propofol, 1 min after rocuronium, and immediately, 1 min, 2 min, and 3 min after intubation. Results SBP, DBP, and MBP decreased after propofol administration and increased immediately after intubation in both groups ( P < 0.05). After intubation, SBP, DBP, and MBP decreased more than baseline values in either group. Although the overall BP of Group P was lower than that of Group MP, there were no significant differences except for SBP at 2min after intubation ( P < 0.05). HR was no significant difference in either group. Conclusion Our results suggest that midazolam-propofol-remifentanil has similar hemodynamic effect with propofol-remifentanil during anesthesia induction in hypertensive patients.
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Wang HY, Ting CK, Liou JY, Chen KH, Tsou MY, Chang WK. A previously published propofol-remifentanil response surface model does not predict patient response well in video-assisted thoracic surgery. Medicine (Baltimore) 2017; 96:e6895. [PMID: 28489797 PMCID: PMC5428631 DOI: 10.1097/md.0000000000006895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Modern anesthesia usually employs a hypnotic and an analgesic to produce synergistic sedation and analgesia. Two remifentanil-propofol interaction response surface models were used to predict sedation using Observer's Assessment of Alertness/Sedation (OAA/S) scores; one predicts an OAA/S <2 and the other <4. We hypothesized that both models would predict regained responsiveness (RR) after video-assisted thoracic surgery (VATS) to reduce total anesthesia time and make early extubation clinically relevant. We included 30 patients undergoing VATS received total intravenous anesthesia (TIVA) combined with thoracic epidural anesthesia (TEA). Pharmacokinetic profiles were calculated using Tivatrainer. Model predictions were compared with observations to evaluate the accuracy and precision of emergence model predictions. The mean (standard deviation) differences between when a patient responded to their name and the time when the model predicted a 50% probability of patient response were 30.80 ± 17.77 and 13.71 ± 11.35 minutes for the OAA/S <2 model and <4 model, respectively. Both models had a limited ability to predict patient response in our patients. Both models identified target concentration pairs predicting time of RR in volunteers and some elective surgeries, but another model of epidural and intravenous anesthetic combinations may be needed to predict time of RR after VATS under TIVA with TEA.
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Affiliation(s)
- Hsin-Yi Wang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
- Institute of Translational and Interdisciplinary Medicine and Department of Biomedical Sciences and Engineering, National Central University, Chungli
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Kun-Hui Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang-Ming University
| | - Mei-Young Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
| | - Wen-Kuei Chang
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei
- Department of Anesthesiology, Taipei Veterans General Hospital and Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
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Affiliation(s)
- J. J. Pandit
- Nuffield Department of Anaesthetics; Oxford University Hospitals; Oxford UK
- St John's College; Oxford UK
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Niu B, Xiao JY, Fang Y, Zhou BY, Li J, Cao F, Tian YK, Mei W. Sevoflurane-induced isoelectric EEG and burst suppression: differential and antagonistic effect of added nitrous oxide. Anaesthesia 2017; 72:570-579. [PMID: 28272748 PMCID: PMC5413860 DOI: 10.1111/anae.13843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 01/04/2023]
Abstract
The objective of this study was to investigate whether nitrous oxide influenced the ED50 of sevoflurane for induction of isoelectric electroencephalogram (ED50isoelectric ) differently from its influence on the ED50 of sevoflurane for electroencephalogram burst suppression (ED50burst ). In a prospective, randomised, double-blind, parallel group, up-down sequential allocation study, 77 ASA physical status 1 and 2 patients received sevoflurane induction and, after tracheal intubation, were randomly allocated to receive sevoflurane with either 40% oxygen in air (control group) or 60% nitrous oxide in oxygen mixture (nitrous group). The ED50isoelectric in the two groups was determined using Dixon's up and down method, starting at 2.5% with 0.2% step size of end-tidal sevoflurane. The electroencephalogram was considered as isoelectric when a burst suppression ratio of 100% lasted > 1 min. The subsequent concentrations of sevoflurane administered were determined by the presence or absence of isoelectric electroencephalogram in the previous patient in the same group. The ED50isoelectric in the nitrous group 4.08 (95%CI, 3.95-4.38)% was significantly higher than that in the control group 3.68 (95%CI, 3.50-3.78)% (p < 0.0001). The values for ED50burst were 3.05 (95%CI, 2.66-3.90)% and 3.02 (95%CI, 3.00-3.05)% in nitrous group and control group, respectively (p = 0.52). The addition of 60% nitrous oxide increases ED50isoelectric , but not the ED50burst of sevoflurane. Neither result indicates an additive effect of anaesthetic agents, as might be expected, and possible reasons for this are discussed.
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Affiliation(s)
- B Niu
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Y Xiao
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Fang
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - B Y Zhou
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Li
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - F Cao
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y K Tian
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - W Mei
- Department of Anaesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jia N, Zuo X, Guo C, Li Y, Cui J, Zhao C, Cao S, Wang C, Li R, Wu Y, Wen A. Synergistic antinociceptive effects of alfentanil and propofol in the formalin test. Mol Med Rep 2017; 15:1893-1899. [DOI: 10.3892/mmr.2017.6174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/02/2016] [Indexed: 11/05/2022] Open
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Lai HC, Chan SM, Lu CH, Wong CS, Cherng CH, Wu ZF. Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery. Medicine (Baltimore) 2017; 96:e6148. [PMID: 28207547 PMCID: PMC5319536 DOI: 10.1097/md.0000000000006148] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.
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Affiliation(s)
- Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Chueng-He Lu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Chih-Shung Wong
- Division of Anesthesiology, Cathay General Hospital, Taipei, Taiwan, Republic of China
| | - Chen-Hwan Cherng
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center
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87
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Brosnan RJ, Fukushima FB, Pham TL. Anesthetic synergy between two n-alkanes. Vet Anaesth Analg 2017; 44:577-588. [PMID: 28583773 DOI: 10.1016/j.vaa.2016.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/28/2016] [Accepted: 07/03/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE N-butane and n-pentane can both produce general anesthesia. Both compounds potentiate γ-aminobutyric acid type A (GABAA) receptor function, but only butane inhibits N-methyl-d-aspartate (NMDA) receptors. It was hypothesized that butane and pentane would exhibit anesthetic synergy due to their different actions on ligand-gated ion channels. STUDY DESIGN Prospective experimental study. ANIMALS A total of four Xenopus laevis frogs and 43 Sprague-Dawley rats. METHODS Alkane concentrations for all studies were determined via gas chromatography. Using a Xenopus oocyte expression model, standard two-electrode voltage clamp techniques were used to measure NMDA and GABAA receptor responses in vitro as a function of butane and pentane concentrations relevant to anesthesia. The minimum alveolar concentrations (MAC) of butane and pentane were measured separately in rats, and then pentane MAC was measured during coadministration of 0.25, 0.50 or 0.75 times MAC of butane. An isobole with 95% confidence intervals was constructed using regression analysis. A sum of butane and pentane that was statistically less than the lower-end confidence bound isobole indicated a synergistic interaction. RESULTS Both butane and pentane dose-dependently potentiated GABAA receptor currents over the study concentration range. Butane dose-dependently inhibited NMDA receptor currents, but pentane did not modulate NMDA receptors. Butane and pentane MAC in rats was 39.4±0.7 and 13.7±0.4 %, respectively. A small but significant (p<0.03) synergistic anesthetic effect with pentane was observed during administration of either 0.50 or 0.75×MAC butane. CONCLUSIONS Butane and pentane show synergistic anesthetic effects in vivo consistent with their different in vitro receptor effects. CLINICAL RELEVANCE Findings support the relevance of NMDA receptors in mediating anesthetic actions for some, but not all, inhaled agents.
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Affiliation(s)
- Robert J Brosnan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA.
| | - Fabíola B Fukushima
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - Trung L Pham
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, USA
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88
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Chan WH, Lee MS, Lin C, Wu CC, Lai HC, Chan SM, Lu CH, Cherng CH, Wu ZF. Comparison of Anesthesia-Controlled Operating Room Time between Propofol-Based Total Intravenous Anesthesia and Desflurane Anesthesia in Open Colorectal Surgery: A Retrospective Study. PLoS One 2016; 11:e0165407. [PMID: 27780241 PMCID: PMC5079552 DOI: 10.1371/journal.pone.0165407] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/21/2016] [Indexed: 12/28/2022] Open
Abstract
We conducted a retrospective study to investigate the anesthesia-controlled time and factors that contribute to prolonged extubation in open colorectal surgery. Using our hospital database, demographic data, various time intervals (waiting for anesthesia time, anesthesia time, surgical time, emergence time, exit from operating room after extubation, total operating room time, and post-anesthesia care unit stay time), and incidence of prolonged extubation (≥ 15 mins), were compared between patients who received desflurane/fentanyl-based anesthesia and total intravenous anesthesia via target-controlled infusion with fentanyl/propofol. Logistic regression analyses were performed to assess the association between variables that contributed to prolonged extubation. In conclusion, the anesthesia-controlled time was similar in desflurane anesthesia and propofol-based total intravenous anesthesia for open colorectal surgery in our hospital. Surgical time greater than 210 minutes, as well as age, contributed to prolonged extubation.
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Affiliation(s)
- Wei-Hung Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Meei-Shyuan Lee
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chang-Chieh Wu
- Department of Surgery, Division of Colorectal Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Hou-Chuan Lai
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chueng-He Lu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chen-Hwan Cherng
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Zhi-Fu Wu
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China
- * E-mail:
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89
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Heo YA, Holford N, Kim Y, Son M, Park K. Quantitative model for the blood pressure-lowering interaction of valsartan and amlodipine. Br J Clin Pharmacol 2016; 82:1557-1567. [PMID: 27504853 DOI: 10.1111/bcp.13082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/03/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022] Open
Abstract
AIMS The objective of this study was to develop a population pharmacokinetic (PK) and pharmacodynamic (PD) model to quantitatively describe the antihypertensive effect of combined therapy with amlodipine and valsartan. METHODS PK modelling was used with data collected from 48 healthy volunteers receiving a single dose of combined formulation of 10 mg amlodipine and 160 mg valsartan. Systolic (SBP) and diastolic blood pressure (DBP) were recorded during combined administration. SBP and DBP data for each drug alone were gathered from the literature. PKPD models of each drug and for combined administration were built with NONMEM 7.3. RESULTS A two-compartment model with zero order absorption best described the PK data of both drugs. Amlodipine and valsartan monotherapy effects on SBP and DBP were best described by an Imax model with an effect compartment delay. Combined therapy was described using a proportional interaction term as follows: (D1 + D2 ) +ALPHA×(D1 × D2 ). D1 and D2 are the predicted drug effects of amlodipine and valsartan monotherapy respectively. ALPHA is the interaction term for combined therapy. Quantitative estimates of ALPHA were -0.171 (95% CI: -0.218, -0.143) for SBP and -0.0312 (95% CI: -0.07739, -0.00283) for DBP. These infra-additive interaction terms for both SBP and DBP were consistent with literature results for combined administration of drugs in these classes. CONCLUSION PKPD models for SBP and DBP successfully described the time course of the antihypertensive effects of amlodipine and valsartan. An infra-additive interaction between amlodipine and valsartan when used in combined administration was confirmed and quantified.
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Affiliation(s)
- Young-A Heo
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Nick Holford
- Department of Pharmacology & Clinical Pharmacology, University of Auckland, New Zealand
| | - Yukyung Kim
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Mijeong Son
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 Plus Project for Medical Science, Yonsei University, Seoul, South Korea
| | - Kyungsoo Park
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, South Korea
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90
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Kesić S, Spasić SZ. Application of Higuchi's fractal dimension from basic to clinical neurophysiology: A review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 133:55-70. [PMID: 27393800 DOI: 10.1016/j.cmpb.2016.05.014] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/24/2016] [Accepted: 05/27/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE For more than 20 years, Higuchi's fractal dimension (HFD), as a nonlinear method, has occupied an important place in the analysis of biological signals. The use of HFD has evolved from EEG and single neuron activity analysis to the most recent application in automated assessments of different clinical conditions. Our objective is to provide an updated review of the HFD method applied in basic and clinical neurophysiological research. METHODS This article summarizes and critically reviews a broad literature and major findings concerning the applications of HFD for measuring the complexity of neuronal activity during different neurophysiological conditions. The source of information used in this review comes from the PubMed, Scopus, Google Scholar and IEEE Xplore Digital Library databases. RESULTS The review process substantiated the significance, advantages and shortcomings of HFD application within all key areas of basic and clinical neurophysiology. Therefore, the paper discusses HFD application alone, combined with other linear or nonlinear measures, or as a part of automated methods for analyzing neurophysiological signals. CONCLUSIONS The speed, accuracy and cost of applying the HFD method for research and medical diagnosis make it stand out from the widely used linear methods. However, only a combination of HFD with other nonlinear methods ensures reliable and accurate analysis of a wide range of neurophysiological signals.
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Affiliation(s)
- Srdjan Kesić
- University of Belgrade, Institute for Biological Research "Siniša Stanković", Department of Neurophysiology, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia
| | - Sladjana Z Spasić
- University of Belgrade, Institute for Multidisciplinary Research, Department of Life Sciences, Kneza Višeslava 1, 11030 Belgrade, Serbia; Singidunum University, Danijelova 32, 11010 Belgrade, Serbia.
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91
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Wiczling P, Bieda K, Przybyłowski K, Hartmann-Sobczyńska R, Borsuk A, Matysiak J, Kokot ZJ, Sobczyński P, Grześkowiak E, Bienert A. Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery - a study of pharmacodynamic drug-drug interactions. Biopharm Drug Dispos 2016; 37:252-63. [DOI: 10.1002/bdd.2009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/13/2016] [Accepted: 03/07/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Paweł Wiczling
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdańsk; Poland
| | - Krzysztof Bieda
- Department of Anesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Krzysztof Przybyłowski
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Roma Hartmann-Sobczyńska
- Department of Experimental Anesthesiology; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Agnieszka Borsuk
- Department of Biopharmaceutics and Pharmacodynamics; Medical University of Gdańsk; Poland
| | - Jan Matysiak
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Zenon J. Kokot
- Department of Inorganic and Analytical Chemistry; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Paweł Sobczyński
- Department of Anesthesiology and Intensive Therapy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
| | - Agnieszka Bienert
- Department of Clinical Pharmacy and Biopharmacy; Karol Marcinkowski University of Medical Sciences; Poznań Poland
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92
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Common Internal Allosteric Network Links Anesthetic Binding Sites in a Pentameric Ligand-Gated Ion Channel. PLoS One 2016; 11:e0158795. [PMID: 27403526 PMCID: PMC4942068 DOI: 10.1371/journal.pone.0158795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 06/22/2016] [Indexed: 01/10/2023] Open
Abstract
General anesthetics bind reversibly to ion channels, modifying their global conformational distributions, but the underlying atomic mechanisms are not completely known. We examine this issue by way of the model protein Gloeobacter violaceous ligand-gated ion channel (GLIC) using computational molecular dynamics, with a coarse-grained model to enhance sampling. We find that in flooding simulations, both propofol and a generic particle localize to the crystallographic transmembrane anesthetic binding region, and that propofol also localizes to an extracellular region shared with the crystallographic ketamine binding site. Subsequent simulations to probe these binding modes in greater detail demonstrate that ligand binding induces structural asymmetry in GLIC. Consequently, we employ residue interaction correlation analysis to describe the internal allosteric network underlying the coupling of ligand and distant effector sites necessary for conformational change. Overall, the results suggest that the same allosteric network may underlie the actions of various anesthetics, regardless of binding site.
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93
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Cao S, Li Y, Wang L, Cui J, Jia N, Li R, Zhao C, Wang C, Wu Y, Wen A. Synergistic analgesic effect of propofol-alfentanil combination through detecting the inhibition of cAMP signal pathway. ACTA ACUST UNITED AC 2016; 68:1170-6. [PMID: 27334358 DOI: 10.1111/jphp.12578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/30/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The study aims to investigate the possible mechanism of the synergistic analgesic effect of propofol-alfentanil combination. METHODS The synergistic analgesic effects of propofol-alfentanil combination in Sprague-Dawley (SD) rats were analysed through the von Frey test. Then, we examined the activity of phospholipase C (PLC) and the intracellular levels of Ca(2+) and adenosine 3', 5'cyclic monophosphate (cAMP) in primary neuronal cells of fetal SD rats. We detected the intracellular Ca(2+) concentration by fluorescence and flow cytometry. The PLC activity of the primary neuronal cells was assayed using the EnzChek(®) Direct Phospholipase C Assay Kit. The cAMP content of the cells was assayed using the cAMP Direct Immunoassay Kit (Fluorometric). KEY FINDINGS Both propofol and alfentanil treatments depressed cAMP levels and PLC activity, but propofol-alfentanil combination decreased these parameters to a greater extent than alfentanil treatment alone. Propofol and alfentanil both inhibited Ca(2+) channel, but propofol-alfentanil combination suppressed this channel to a greater extent than alfentanil treatment alone. Fluorescent image analysis revealed that both propofol and alfentanil reduced the intracellular levels of Ca(2+) , and propofol-alfentanil combination showed weaker signals than alfentanil alone. Propofol-alfentanil combination significantly reduced intracellular Ca(2+) level, cAMP level and PLC activity. CONCLUSION Propofol and alfentanil exert synergistic analgesic effects through the adenylyl cyclase pathway.
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Affiliation(s)
- Shanshan Cao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuwen Li
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lu Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jia Cui
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Na Jia
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ruili Li
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chao Zhao
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chao Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yin Wu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Aidong Wen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Yuan F, Fu H, Yang P, Sun K, Wu S, Lv M, Dong Z, Dong T. Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study. Exp Ther Med 2016; 12:506-512. [PMID: 27347086 DOI: 10.3892/etm.2016.3274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 02/18/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the effect of a combination of dexmedetomidine and fentanyl on peripheral oxygen saturation (SpO2) and hemodynamic stability in patients undergoing flexible bronchoscopy. One hundred patients undergoing elective flexible bronchoscopy were randomized into either a propofol-fentanyl group (PF group; n=50) or a dexmedetomidine-fentanyl group (DF group; n=50). SpO2 values, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), patients' cough scores and discomfort scores as determined by patients and bronchoscopists, levels of sedation, number of times that additional lidocaine was required, elapsed time until recovery, and adverse events were recorded. The mean SpO2 values in the DF group were significantly higher than those in the PF group (P<0.01), and HR, SBP and DBP were significantly lower in the DF group than in the PF group (P<0.05). There were no statistically significant differences between the two groups in terms of cough scores or discomfort scores, sedation levels, or number of times that additional lidocaine was required (P>0.05). Elapsed time until recovery in the DF group was significantly longer than in the PF group (P=0.002). The incidence of hypoxemia was significantly lower in the DF group than in the PF group (P=0.027), but the incidence of bradycardia was significantly higher in the DF group than in the PF group (P=0.037). Dexmedetomidine-fentanyl was superior to propofol-fentanyl in providing satisfactory SpO2. Furthermore, dexmedetomidine-fentanyl attenuated hemodynamic responses during bronchoscopy and maintained hemodynamic stability in the early stage of the procedure.
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Affiliation(s)
- Feng Yuan
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Hongguang Fu
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Pengju Yang
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Kai Sun
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Shubiao Wu
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Miaomiao Lv
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Zhenzhen Dong
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
| | - Tieli Dong
- Department of Anesthesiology, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450014, P.R. China
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95
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Choi JJ, Kim JY, Lee D, Chang YJ, Cho NR, Kwak HJ. Male patients require higher optimal effect-site concentrations of propofol during i-gel insertion with dexmedetomidine 0.5 μg/kg. BMC Anesthesiol 2016; 16:20. [PMID: 27004426 PMCID: PMC4804608 DOI: 10.1186/s12871-016-0186-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 03/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pharmacokinetics and pharmacodynamics of an anesthetic drug may be influenced by gender. The purpose of this study was to compare effect-site half maximal effective concentrations (EC50) of propofol in male and female patients during i-gel insertion with dexmedetomidine 0.5 μg/kg without muscle relaxants. METHODS Forty patients, aged 20-46 years of ASA physical status I or II, were allocated to one of two groups by gender (20 patients per group). After the infusion of dexmedetomidine 0.5 μg/kg over 2 min, anesthesia was induced with a pre-determined effect-site concentration of propofol by target controlled infusion. Effect-site EC50 values of propofol for successful i-gel insertion were determined using the modified Dixon's up-and-down method. RESULTS Mean effect-site EC50 ± SD of propofol for successful i-gel insertion was significantly higher for men than women (5.46 ± 0.26 μg/ml vs. 3.82 ± 0.34 μg/ml, p < 0.01). The EC50 of propofol in men was approximately 40% higher than in women. Using isotonic regression with a bootstrapping approach, the estimated EC50 (95% confidence interval) of propofol was also higher in men [5.32 (4.45-6.20) μg/ml vs. 3.75 (3.05-4.43) μg/ml]. The estimated EC95 (95% confidence interval) of propofol in men and women were 5.93 (4.72-6.88) μg/ml and 4.52 (3.02-5.70) μg/ml, respectively. CONCLUSIONS During i-gel insertion with dexmedetomidine 0.5 μg/kg without muscle relaxant, male patients had higher effect-site EC50 for propofol using Schnider's model. Based on the results of this study, patient gender should be considered when determining the optimal dose of propofol during supraglottic airway insertion. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02268656. Registered August 26, 2014.
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Affiliation(s)
- Jung Ju Choi
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesiology and Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Dongchul Lee
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Young Jin Chang
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Noo Ree Cho
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea
| | - Hyun Jeong Kwak
- Department of Anesthesiology and Pain Medicine, Gachon University, Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea.
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Shoushtarian M, Sahinovic MM, Absalom AR, Kalmar AF, Vereecke HEM, Liley DTJ, Struys MMRF. Comparisons of Electroencephalographically Derived Measures of Hypnosis and Antinociception in Response to Standardized Stimuli During Target-Controlled Propofol-Remifentanil Anesthesia. Anesth Analg 2016; 122:382-92. [DOI: 10.1213/ane.0000000000001029] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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97
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Choi BM. An overview of pharmacodynamic drug interaction with isobole and response surface model in anesthesia. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Byung Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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98
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A method for continuous and stable perfusion of tissue and single cell preparations with accurate concentrations of volatile anaesthetics. J Neurosci Methods 2016; 258:87-93. [DOI: 10.1016/j.jneumeth.2015.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 11/30/2022]
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99
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Liou JY, Tsou MY, Ting CK. Response surface models in the field of anesthesia: A crash course. ACTA ACUST UNITED AC 2015; 53:139-45. [PMID: 26321504 DOI: 10.1016/j.aat.2015.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 06/17/2015] [Accepted: 06/29/2015] [Indexed: 11/24/2022]
Abstract
Drug interaction is fundamental in performing anesthesia. A response surface model (RSM) is a very useful tool for investigating drug interactions. The methodology appeared many decades ago, but did not receive attention in the field of anesthesia until the 1990s. Drug investigations typically start with pharmacokinetics, but it is the effects on the body clinical anesthesiologists really care about. Typically, drug interactions are divided into additive, synergistic, or infra-additive. Traditional isobolographic analysis or concentration-effect curve shifts are limited to a single endpoint. Response surface holds the complete package of isobolograms and concentration effect curves in one equation for a given endpoint, e.g., loss of response to laryngoscopy. As a pharmacodynamic tool, RSM helps anesthesiologists guide their drug therapy by navigating the surface. We reviewed the most commonly used models: (1) the Greco model; (2) Reduced Greco model; (3) Minto model; and (4) the Hierarchy models. Each one has its unique concept and strengths. These models served as groundwork for researchers to modify the formula to fit their drug of interest. RSM usually work with two drugs, but three-drug models can be constructed at the expense of greatly increasing the complexity. A wide range of clinical applications are made possible with the help of pharmacokinetic simulation. Pharmacokinetic-pharmcodynamic modeling using the RSMs gives anesthesiologists the versatility to work with precision and safe drug interactions. Currently, RSMs have been used for predicting patient responses, estimating wake up time, pinpointing the optimal drug concentration, guide therapy with respect to patient's well-being, and aid in procedures that require rapid patient arousal such as awake craniotomy or Stagnara wake-up test. There is no other model that is universally better than the others. Researches are encouraged to find the best fitting model for different occasions with an objective measure.
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Affiliation(s)
- Jing-Yang Liou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC
| | - Mei-Yung Tsou
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC; National Yang-Ming University and School of Medicine, Taipei, Taiwan, ROC
| | - Chien-Kun Ting
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan, ROC; National Yang-Ming University and School of Medicine, Taipei, Taiwan, ROC.
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Li P, Bracamontes JR, Manion BD, Mennerick S, Steinbach JH, Evers AS, Akk G. The neurosteroid 5β-pregnan-3α-ol-20-one enhances actions of etomidate as a positive allosteric modulator of α1β2γ2L GABAA receptors. Br J Pharmacol 2015; 171:5446-57. [PMID: 25117207 DOI: 10.1111/bph.12861] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/11/2014] [Accepted: 07/20/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurosteroids potentiate responses of the GABAA receptor to the endogenous agonist GABA. Here, we examined the ability of neurosteroids to potentiate responses to the allosteric activators etomidate, pentobarbital and propofol. EXPERIMENTAL APPROACH Electrophysiological assays were conducted on rat α1β2γ2L GABAA receptors expressed in HEK 293 cells. The sedative activity of etomidate was studied in Xenopus tadpoles and mice. Effects of neurosteroids on etomidate-elicited inhibition of cortisol synthesis were determined in human adrenocortical cells. KEY RESULTS The neurosteroid 5β-pregnan-3α-ol-20-one (3α5βP) potentiated activation of GABAA receptors by GABA and allosteric activators. Co-application of 1 μM 3α5βP induced a leftward shift (almost 100-fold) of the whole-cell macroscopic concentration-response relationship for gating by etomidate. Co-application of 100 nM 3α5βP reduced the EC50 for potentiation by etomidate of currents elicited by 0.5 μM GABA by about three-fold. In vivo, 3α5βP (1mg kg(-1) ) reduced the dose of etomidate required to produce loss of righting in mice (ED50 ) by almost 10-fold. In tadpoles, the presence of 50 or 100 nM 3α5βP shifted the EC50 for loss of righting about three- or ten-fold respectively. Exposure to 3α5βP did not influence inhibition of cortisol synthesis by etomidate. CONCLUSIONS AND IMPLICATIONS Potentiating neurosteroids act similarly on orthosterically and allosterically activated GABAA receptors. Co-application of neurosteroids with etomidate can significantly reduce dosage requirements for the anaesthetic, and is a potentially beneficial combination to reduce undesired side effects.
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Affiliation(s)
- P Li
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
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