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Miller M, Melis MJ, Miller JRC, Kleyman A, Shankar-Hari M, Singer M. Antibiotics, Sedatives, and Catecholamines Further Compromise Sepsis-Induced Immune Suppression in Peripheral Blood Mononuclear Cells. Crit Care Med 2024; 52:596-606. [PMID: 38483219 DOI: 10.1097/ccm.0000000000006119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
OBJECTIVES We hypothesized that the immunosuppressive effects associated with antibiotics, sedatives, and catecholamines amplify sepsis-associated immune suppression through mitochondrial dysfunction, and there is a cumulative effect when used in combination. We thus sought to determine the impact of the exemplar drugs ciprofloxacin, propofol, and norepinephrine, used alone and in combination, at clinically relevant concentrations, on the ex vivo functionality of peripheral blood mononuclear cells (PBMCs) drawn from healthy, infected, and septic individuals. DESIGN In vitro/ex vivo investigation. SETTING University laboratory. SUBJECTS Healthy volunteers, infected (nonseptic) patients in the emergency department, and septic ICU patients. INTERVENTIONS PBMCs were isolated from these subjects and treated with ciprofloxacin (100 µg/mL), propofol (50 µg/mL), norepinephrine (10 µg/mL), or all three drugs combined, with and without lipopolysaccharide (100 ng/mL) for 6 or 24 hours. Comparison was made between study groups and against untreated cells. Measurements were made of cell viability, cytokine production, phagocytosis, human leukocyte antigen-DR (HLA-DR) status, mitochondrial membrane potential, mitochondrial reactive oxygen species production, and oxygen consumption. Gene expression in immune and metabolic pathways was investigated in PBMCs sampled from healthy volunteers coincubated with septic serum. MEASUREMENTS AND RESULTS Coincubation with each of the drugs reduced cytokine production and phagocytosis in PBMCs isolated from septic patients, and healthy volunteers coincubated with septic serum. No effect was seen on HLA-DR surface expression. No cumulative effects were seen with the drug combination. Sepsis-induced changes in gene expression and mitochondrial functionality were not further affected by addition of any of the drugs. CONCLUSION Drugs commonly used in critical care lead to significant immune dysfunction ex vivo and enhance sepsis-associated immunosuppression. Further studies are required to identify underlying mechanisms and potential impact on patient outcomes.
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Affiliation(s)
- Muska Miller
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Miranda J Melis
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - James R C Miller
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Anna Kleyman
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
| | - Manu Shankar-Hari
- Centre for Inflammation Research, Institute for Regeneration and Repair, Edinburgh, United Kingdom
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom
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Effect of General Anesthesia Maintenance with Propofol or Sevoflurane on Fractional Exhaled Nitric Oxide and Eosinophil Blood Count: A Prospective, Single Blind, Randomized, Clinical Study on Patients Undergoing Thyroidectomy. J Pers Med 2022; 12:jpm12091455. [PMID: 36143240 PMCID: PMC9505258 DOI: 10.3390/jpm12091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Nitric oxide (NO) is considered a means of detecting airway hyperresponsiveness, since even non-asthmatic patients experiencing bronchospasm intraoperatively or postoperatively display higher levels of exhaled NO. It can also be used as a non-invasive biomarker of lung inflammation and injury. This prospective, single-blind, randomized study aimed to evaluate the impact of two different anesthesia maintenance techniques on fractional exhaled nitric oxide (FeΝO) in patients without respiratory disease undergoing total thyroidectomy under general anesthesia. Methods: Sixty patients without respiratory disease, atopy or known allergies undergoing total thyroidectomy were randomly allocated to receive either inhalational anesthesia maintenance with sevoflurane at a concentration that maintained Bispectral Index (BIS) values between 40 and 50 intraoperatively or intravenous anesthesia maintenance with propofol 1% targeting the same BIS values. FeΝO was measured immediately preoperatively (baseline), postoperatively in the Postanesthesia Care Unit and at 24 h post-extubation with a portable device. Other variables measured were eosinophil blood count preoperatively and postoperatively and respiratory parameters intraoperatively. Results: Patients in both groups presented lower than baseline values of FeΝO measurements postoperatively, which returned to baseline measurements at 24 h post-extubation. In the peripheral blood, a decrease in the percentage of eosinophils was demonstrated, which was significant only in the propofol group. Respiratory lung mechanics were better maintained in the propofol group as compared to the sevoflurane group. None of the patients suffered intraoperative bronchospasm. Conclusions: Both propofol and sevoflurane lead to the temporary inhibition of NO exhalation. They also seem to attenuate systemic hypersensitivity response by reducing the eosinophil count in the peripheral blood, with propofol displaying a more pronounced effect and ensuring a more favorable mechanical ventilation profile as compared to sevoflurane. The attenuation of NO exhalation by both agents may be one of the underlying mechanisms in the reduction in airway hyperreactivity. The clinical significance of this fluctuation remains to be studied in patients with respiratory disease.
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3
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Lu X, Yu Y, Wang Y, Lyu Y. Effect of Propofol or Etomidate as General Anaesthesia Induction on Gastric Cancer: A Retrospective Cohort Study with 10 Years' Follow-Up. Cancer Manag Res 2022; 14:2399-2407. [PMID: 35967754 PMCID: PMC9373996 DOI: 10.2147/cmar.s361052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022] Open
Abstract
Objective The aim is to study the effect of intraoperative application of propofol and etomidate on the long-term prognosis of patients with gastric cancer at the same tumor stage. Methods A total of 1018 patients who underwent radical gastric cancer surgery at the First Affiliated Hospital of Anhui Medical University from January 2010 to December 2010 were selected and divided into the propofol and etomidate groups according to the different anesthetic induction drugs. Results Among 244 patients in TNM stage IIIA, survival times were 36.10 and 41.79 for etomidate and propofol, respectively, which were statistically different (p < 0.05). Among the 82 patients in TNM stage IIIC, survival times were 26.57 and 35.20 for etomidate and propofol, respectively, which were statistically different (p < 0.05). Conclusion In patients undergoing radical gastric cancer surgery, the application of propofol during induction of anaesthesia is more beneficial in improving the postoperative survival time compared to the application of etomidate at a specific TNM stage.
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Affiliation(s)
- Xianfu Lu
- Department of Anesthesiology High Tech Branch, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.,Department of Anesthesiology, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yue Yu
- Department of Anesthesiology, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yan Wang
- Department of Anesthesiology High Tech Branch, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yi Lyu
- Department of Anesthesiology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China
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Bredthauer A, Geiger A, Gruber M, Pfaehler SM, Petermichl W, Bitzinger D, Metterlein T, Seyfried T. Propofol Ameliorates Exaggerated Human Neutrophil Activation in a LPS Sepsis Model. J Inflamm Res 2021; 14:3849-3862. [PMID: 34408467 PMCID: PMC8366786 DOI: 10.2147/jir.s314192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background Sepsis is a leading cause of morbidity and mortality worldwide. Many patients suffering from sepsis are treated on intensive care units and many of them require mechanical ventilation under sedation or general anesthesia. Propofol, a drug used for these purposes, is known to interact with polymorphonuclear granulocytes (PMNs). Therefore, the aim of this study was to investigate the influence of propofol on PMN functions after experimental Gram-negative induced sepsis using lipopolysaccharide (LPS) stimulation. Methods A total of 34 granulocyte-enriched samples were collected from healthy subjects. PMNs were isolated by density gradient centrifugation and incubated simultaneously with either 6 µg/mL or 60 µg/mL propofol, or none (control). Additionally, the experimental sepsis samples were incubated with either 40 pg/mL or 400 pg/mL LPS. Live cell imaging was conducted in order to observe granulocyte chemotactic migration, ROS production, and NETosis. Flow cytometry was used to analyze viability and antigen expression. Results Propofol led to significantly reduced PMN track length (p < 0.001) and track speed (p < 0.014) after LPS-induced sepsis in a dose-dependent manner. NETosis (p = 0.018) and ROS production (p = 0.039) were accelerated by propofol without LPS incubation, indicating improved immune function. Propofol also ameliorated LPS-induced increased NETosis and ROS-production. Antigen expression for CD11b, CD62l and CD66b was unaffected by propofol. Conclusion Propofol improves LPS-induced exaggerated PMN activation in an ex vivo model. Beneficial effects due to restored immune function in septic patients might be possible, but needs further investigation.
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Affiliation(s)
- Andre Bredthauer
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany.,Department of Neurology at the University of Regensburg - Center for Vascular Neurology and Intensive Care Medicine, Regensburg, Germany
| | - Angela Geiger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Gruber
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Sophie-Marie Pfaehler
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Walter Petermichl
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Diane Bitzinger
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany
| | - Thomas Metterlein
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany.,Department of Anesthesiology, Ansbach Hospital, Ansbach, Germany
| | - Timo Seyfried
- Department of Anesthesiology, University Medical Center Regensburg, Regensburg, Germany.,Department of Anesthesiology, Ernst von Bergmann Hospital, Potsdam, Germany
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5
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Jafarzadeh A, Hadavi M, Hassanshahi G, Rezaeian M, Vazirinejad R. General Anesthetics on Immune System Cytokines: A Narrative Review Article. Anesth Pain Med 2020; 10:e103033. [PMID: 33134146 PMCID: PMC7539048 DOI: 10.5812/aapm.103033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/30/2020] [Accepted: 06/14/2020] [Indexed: 12/15/2022] Open
Abstract
Context According to the previous studies, general anesthesia influences the immune system. Evaluating such impacts on the immune system helps to improve the management of anesthesia. Evidence Acquisition The current review aimed to summarize the literature related to the effects of general anesthesia agents on the cytokines. Google Scholar, PubMed, and ISI/Web of Sciences databases were searched using the following keywords: cytokine, general anesthesia, immune response, intravenous anesthetics, volatile anesthetics, opioids, benzodiazepines, and controlled ventilation. Results Long-term administration of general anesthesia drugs, due to their effects on cytokines, can lead to disease progression in patients with immune deficiency. Due to the conflicting results of various studies and the increasing number of patients with immune deficiency, the choice of the appropriate general anesthesia agents facilitates achieving the more favorable function of the cytokines. Conclusions It seems that the effect of general anesthesia on the immune system in healthy patients and short-term surgeries is not considerable and changes in the immune system are related to surgical trauma, particularly in major surgery.
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Affiliation(s)
- Abdollah Jafarzadeh
- Department of Immunology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Hadavi
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Anesthesiology, Paramedical Faculty, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Corresponding Author: Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - Gholamhossein Hassanshahi
- Molecular Medicine Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Immunology, Faculty of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohsen Rezaeian
- Department of Epidemiology and Biostatistics, Occupational Environmental Research Center, Medical School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Reza Vazirinejad
- Department of Social Medicine, Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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6
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Schaefer MS, Raub D, Xu X, Shay D, Teja B, Chhangani K, Grabitz SD, O'Gara B, Kienbaum P, Houle TT, Landoni G, Eikermann M. Association between propofol dose and 1-year mortality in patients with or without a diagnosis of solid cancer. Br J Anaesth 2020; 124:271-280. [PMID: 31902588 DOI: 10.1016/j.bja.2019.11.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preclinical data suggest suppression of cancer proliferation by propofol, and retrospective studies suggest improved survival after cancer surgery with propofol-based anaesthesia. METHODS To determine whether propofol dose administered for anaesthesia is associated with 1-yr mortality in patients with and without a diagnosis of solid cancer, we analysed adult patients undergoing monitored anaesthesia care or general anaesthesia at two academic medical centres in Boston, MA, USA. Logistic regression with interaction term analysis was applied with propofol dose (mg kg-1) as primary and diagnosis of solid cancer as co-primary exposure, and 1-yr mortality as the primary outcome. RESULTS Of 280 081 patient cases, 10 744 (3.8%) died within 1 yr. Increasing propofol dose was associated with reduced odds of 1-yr mortality (adjusted odds ratio [aOR] 0.93 per 10 mg kg-1; 95% confidence interval [CI]: 0.89-0.98; absolute risk reduction fifth vs first quintile 0.5%; 95% CI: 0.2-0.7). This association was modified by a diagnosis of solid cancer (P<0.001 for interaction). Increasing propofol dose was associated with reduced odds of 1-yr mortality in patients without solid cancer (aOR: 0.78; 95% CI: 0.71-0.85), but not in patients with solid cancer (0.99; 0.94-1.04), a finding that was replicated when examining 5-yr mortality. CONCLUSIONS Increasing propofol dose is associated with lower 1-yr mortality in patients without, but not in patients with, a diagnosis of solid cancer. We found evidence for competing effects, modifying the association between propofol dose and mortality.
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Affiliation(s)
- Maximilian S Schaefer
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Dana Raub
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Center for Anesthesia Research Excellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Denys Shay
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Khushi Chhangani
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Brian O'Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Peter Kienbaum
- Department of Anaesthesiology, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Timothy T Houle
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA; Department of Anaesthesiology and Intensive Care Medicine, University of Duisburg-Essen, Essen, Germany.
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7
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Irwin MG, Chung CKE, Ip KY, Wiles MD. Influence of propofol-based total intravenous anaesthesia on peri-operative outcome measures: a narrative review. Anaesthesia 2020; 75 Suppl 1:e90-e100. [PMID: 31903578 DOI: 10.1111/anae.14905] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 12/12/2022]
Abstract
Propofol-based total intravenous anaesthesia is well known for its smooth, clear-headed recovery and anti-emetic properties, but there are also many lesser known beneficial properties that can potentially influence surgical outcome. We will discuss the anti-oxidant, anti-inflammatory and immunomodulatory effects of propofol and their roles in pain, organ protection and immunity. We will also discuss the use of propofol in cancer surgery, neurosurgery and older patients.
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Affiliation(s)
- M G Irwin
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - C K E Chung
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Ip
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - M D Wiles
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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8
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Alhayyan A, McSorley S, Roxburgh C, Kearns R, Horgan P, McMillan D. The effect of anesthesia on the postoperative systemic inflammatory response in patients undergoing surgery: A systematic review and meta-analysis. Surg Open Sci 2020; 2:1-21. [PMID: 32754703 PMCID: PMC7391900 DOI: 10.1016/j.sopen.2019.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Surgical injury stimulates the systemic inflammatory response. The magnitude of the postoperative systemic inflammatory response has been shown to be significantly associated with short and long-term outcomes following surgery of varying severity. Different anesthetic techniques for surgery may have an impact on the postoperative systemic inflammatory response and on the rate of the postoperative infective complications.The aim of the present systematic review was to examine the relationship between perioperative anesthesia, the postoperative systemic inflammatory response and postoperative infective complications in patients undergoing surgery. METHODS This was carried out using PubMed and other established databases from 1987 up to March 2018. In particular, randomized controlled studies and systemic inflammation markers, interleukin 6 and C-reactive protein were examined. RESULTS Overall, 60 controlled, randomized clinical trials were included in the review. The mean or median values of both interleukin 6 and C-reactive protein were taken for each study and the mean value was calculated for each anesthetic group at sampling points of 12-24 and 24-72 hours for interleukin 6 and C-reactive protein respectively. When taking the magnitude of surgery into account, TIVA using propofol was significantly associated with a reduction in particular C-reactive protein (P = .04). However, there were no other specific anesthetic methods including general, regional and combined anesthetics that were associated with a reduction in either interleukin 6 or C-reactive protein. CONCLUSION There is some evidence that anesthetic regimens may reduce the magnitude of the postoperative systemic inflammatory response. However, the studies were heterogeneous and generally of low quality.Future, well conducted, adequately powered studies are required to clarify the effect of anesthesia on the postoperative systemic inflammatory response and infective complications.
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Affiliation(s)
- Aliah Alhayyan
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Stephen McSorley
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Campbell Roxburgh
- School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Rachel Kearns
- Department of Anaesthetics, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Paul Horgan
- Institute of Cancer Sciences, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
| | - Donald McMillan
- Institute of Cancer Sciences, Department of Surgery, School of Medicine, Dentistry & Nursing - University of Glasgow, Glasgow, UK
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9
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Dexmedetomidine as an Alternative Anesthetic Agent for Flap Surgery: An Intravital Evaluation in the Cremaster Muscle Flap. J Craniofac Surg 2019; 30:2469-2472. [PMID: 31469734 DOI: 10.1097/scs.0000000000005850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Flap surgery is one of the most commonly used techniques of reconstructive surgery for effective repair of damaged tissue. Optimal anesthetic technique and anesthetic agent plays an important role in flap perfusion. This study aimed to evaluate the effects of dexmedetomidine infusion on the microcirculation in the cremaster muscle flap by direct in vivo monitoring. MATERIALS AND METHODS We randomly divided 9 Wistar albino rats into 3 groups. The rats in the control group underwent the surgical procedure (isolation of the cremaster muscle) alone; the rats in the experimental groups 1 and 2 received an infusion of dexmedetomidine (10 and 30 min) after the surgical procedure. RESULTS The means of vessel diameters, number of functional capillaries, and movements of leukocytes in all groups were evaluated using intravital microscopic examination. The diameters of the arterioles and venules of the cremaster muscle significantly increased in the dexmedetomidine groups. The number of functional capillaries was higher in the dexmedetomidine groups than in the control group. No difference was observed in the movements of leukocytes between the control and experimental groups. Dexmedetomidine significantly increased the diameters of the arterioles and venules of the cremaster flap and the number of functional capillaries. CONCLUSION On the basis of the effects of dexmedetomidine on microcirculation, we suggest that dexmedetomidine continue to be used as an anesthetic agent, and may be considered also for reconstructive procedures, particularly flap surgery.
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10
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Kulinska KI, Billert M, Sawinski K, Czerniak K, Gaca M, Kusza K, Nowak KW, Siemionow M, Billert H. Local anaesthetics upregulate nitric oxide generation in cord blood and adult human neutrophils. Sci Rep 2019; 9:569. [PMID: 30679708 PMCID: PMC6346062 DOI: 10.1038/s41598-018-37090-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/03/2018] [Indexed: 02/07/2023] Open
Abstract
Nitric oxide (NO) generation by systemic neonatal neutrophils is not clarified. It is also not known whether local anaesthetics (LAs) transferred to the fetal systemic circulation following maternal epidural blockade may affect this process. In the present study, NO generation was evaluated in neutrophils from cord blood (CB, n = 11) and adult blood (n = 10) following exposure to bupivacaine (0.0005, 0.005, 1 mM), lidocaine (0.002, 0.02, 4 mM) and ropivacaine (0.0007, 0.007, 1.4 mM) using flow cytometry, as well as indirectly by determining nitrite concentrations in cell incubation media. To determine the role of NO synthase (NOS) isoforms in NO generation following exposure to LAs, experiments were repeated in the presence of the NOS inhibitors, NG-nitro-L-arginine methyl ester and aminoguanidine; in addition, the expression of NOS isoforms was analysed. CB neutrophils produced less NO than adult neutrophils. LAs, especially ropivacaine and lidocaine, stimulated neutrophil NO generation, but in CB neutrophils this effect was negligible at clinically relevant drug concentrations. A mechanism involving NOS activity was responsible for the observed phenomena. In conclusion, LAs are able to upregulate neutrophil NO production, but in neonates this effect is likely to be clinically insignificant.
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Affiliation(s)
- Karolina I Kulinska
- Department of Experimental Anaesthesiology, Chair of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 14, Sw. Marii Magdaleny st., 61-861, Poznan, Poland.
| | - Maria Billert
- Department of Animal Physiology and Biochemistry, Poznan University of Life Sciences, 33, Wolynska st., 60-637, Poznan, Poland
| | - Krzysztof Sawinski
- Department of Haematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 82/84, Szamarzewskiego st., 60-569, Poznan, Poland
| | - Katarzyna Czerniak
- Department of Experimental Anaesthesiology, Chair of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 14, Sw. Marii Magdaleny st., 61-861, Poznan, Poland
| | - Michał Gaca
- Clinics of Anaesthesiology in Obstetrics and Gynecology, Chair of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 33, Polna st., 60-101, Poznan, Poland
| | - Krzysztof Kusza
- Clinics of Anaesthesiology and Intensive Therapy, Chair of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 49, Przybyszewskiego st., 60-355, Poznan, Poland
| | - Krzysztof W Nowak
- Department of Animal Physiology and Biochemistry, Poznan University of Life Sciences, 33, Wolynska st., 60-637, Poznan, Poland
| | - Maria Siemionow
- University of Illinois at Chicago, Department of Orthopaedics MC 944, 900 South Ashland Avenue, 3356 MCBRB, Chicago, Illinois, 60607, USA
| | - Hanna Billert
- Department of Experimental Anaesthesiology, Chair of Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 14, Sw. Marii Magdaleny st., 61-861, Poznan, Poland.
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11
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Li P, Guo P, Lin C, He M, Zhu X, Liu C, Tang J, Wang W, Liang W. The synergistic effect of propofol and ulinastatin suppressed the viability of the human lung adenocarcinoma epithelial A549 cell line. Oncol Lett 2018; 16:5191-5199. [PMID: 30250587 PMCID: PMC6144888 DOI: 10.3892/ol.2018.9283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 07/20/2018] [Indexed: 12/17/2022] Open
Abstract
Ulinastatin and propofol (PPF) are recognized for their anticancer properties. The aim of the present study was to evaluate the synergistic antitumor effect of PPF followed by ulinastatin against A549 cells. In MTT assays, PPF (10, 20 and 30 µM) followed by 200 U/ml ulinastatin was more effective at inhibiting A549 cell viability compared with PPF (10, 20 and 30 µM) or 200 U/ml ulinastatin. PPF (10, 20 and 30 µM) followed by 200 U/ml ulinastatin treatments synergistically increased the number of S cells and synergistically reduced the number of G2/M cells associated with PPF stimulation in a dose-dependent manner. Western blot analysis demonstrated that the antitumor effect of PPF followed by 200 U/ml ulinastatin treatments were associated with the downregulated expression of extracellular signal-regulated kinase 1 and 2 phosphorylation (p-ERK1/2) and matrix metalloproteinases 2 (MMP-2). In conclusion, these data demonstrated that PPF (20 and 30 µM) followed by 200 U/ml ulinastatin treatments synergistically stimulated a significant proportion of A549 cells in S phase. Furthermore, the combination synergistically reduced a significant proportion of A549 cells in G2/M phase and synergistically suppressed the viability of A549 cells, which was possibly related regulation of the expression of p-ERK1/2 and MMP-2 in A549 cells.
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Affiliation(s)
- Ping Li
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Peipei Guo
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Chunshui Lin
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Murong He
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiaoqing Zhu
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Chuan Liu
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Jing Tang
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Wei Wang
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Weidong Liang
- Department of Anesthesia, First Affiliated Hospital, Gannan Medical College, Ganzhou, Jiangxi 341000, P.R. China
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Guo F, Ding Y, Yu X, Cai X. Effect of dexmedetomidine, midazolam, and propofol on lipopolysaccharide-stimulated dendritic cells. Exp Ther Med 2018; 15:5487-5494. [PMID: 29904429 DOI: 10.3892/etm.2018.6094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 03/09/2018] [Indexed: 12/17/2022] Open
Abstract
Dexmedetomidine, midazolam and propofol are common sedative drugs used in the intensive care unit. Lipopolysaccharides (LPS) are a potent inducer of human dendritic cells (DCs) maturation and survival, which induces cytokine production. The present study aimed to investigate the effect and mechanisms of sedative drugs on LPS-induced cytokine production in DCs. The mouse bone marrow-derived dendritic DC2.4 cell line was used in the present study. The Cell Counting Kit-8 assay was used to measure the viability of cells. Tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10 mRNA expression levels and contents were measured using reverse transcription-quantitative polymerase chain reaction and ELISA, respectively. The expression levels of proteins associated with nuclear factor-κB (NF-κB) and mitogen activated protein kinase signaling pathways were assessed by western blotting. The three sedatives had different roles on TNF-α, IL-1β, IL-6, and IL-10 mRNA expression levels and content in DCs. Dexmedetomidine promoted inflammatory cytokine production at high clinical concentrations (10, 1 and 0.1 µM), however suppressed them at the lowest clinical concentration (0.001 µM), which was associated with NF-κB and c-Jun N-terminal kinase (JNK)-mitogen-activated protein kinase (MAPK) signaling. Midazolam inhibited inflammatory cytokine production via suppression of the NF-κB and JNK signaling pathways. Propofol partly inhibited inflammatory cytokine production, including IL-1β and IL-6, and the anti-inflammatory effect may result from inhibition of JNK-MAPK, and enhanced NF-κB and extracellular signal-regulated kinase-MAPK signaling at clinical concentrations. The present study helped to elucidate the function of sedatives in LPS-induced cytokine production in DCs, which will facilitate rational implementation of these sedatives in patients undergoing tracheal intubation with sepsis or multiple organ dysfunction syndrome.
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Affiliation(s)
- Feng Guo
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
| | - Ying Ding
- Department of Intensive Care Unit, Sir Run Run Shaw Hospital Xiasha Campus, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
| | - Xue Yu
- Department of Medicine, Tengzhou Central People's Hospital, Zaozhuang, Shandong 277500, P.R. China
| | - Xiujun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
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Sato R, Aoki T, Kobayashi S, Uchida N, Simamura S, Yamasaki M. The modulating effects of propofol and its lipid carrier on canine neutrophil functions. J Vet Med Sci 2016; 78:1825-1829. [PMID: 27665993 PMCID: PMC5240761 DOI: 10.1292/jvms.16-0025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Propofol (2,6-diisopropylphenol), being used as an intravenous sedative and anesthetic
agent, influences not only upon nervous system but also for host inflammatory response
through modulating neutrophil functions. This study is designed to evaluate the modulating
effects of propofol and its lipid carrier administration at clinically relevant rate on
canine neutrophil functions. Clinically healthy beagle dogs were received propofol (8.8
mg/kg) from cephalic vein and maintained with propofol dropping infusion (26.4 mg/kg/hr).
Blood samples were collected from the dogs before infusion and 30 min after the start of
propofol administration, and neutrophil functions were evaluated. The dogs were also
administered lipid carrier, and neutrophil functions were evaluated in the same manner as
propofol administration. Peripheral white blood cell and neutrophil counts decreased after
the propofol or lipid carrier administration. The administration of propofol or lipid
carrier significantly reduced neutrophil adherence ability. The superoxide production of
neutrophils was measured by luminol-dependent chemiluminescence response using with
opsonized zymosan. Peak height of neutrophil chemiluminescence curve was reduced by
propofol and lipid carrier administration, on the contrary, peak time of neutrophil
chemiluminescence curve was delayed. Administration of propofol or lipid carrier also
reduced neutrophil adherence ability to nylon fibers. In the present study, we showed the
modulating effects of propofol and its lipid carrier on canine neutrophil functions.
However, there was no significant difference in the modulating effects between propofol
group and lipid carrier group. Therefore, the modulating effects observed here were deeply
concerned in lipid carrier administration.
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Affiliation(s)
- Reeko Sato
- Department of Veterinary Medicine, Faculty of Agriculture, Iwate University, 3-18-8, Ueda, Morioka, Iwate 020-8550, Japan
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Regulatory effects of anesthetics on nitric oxide. Life Sci 2016; 151:76-85. [DOI: 10.1016/j.lfs.2016.02.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/20/2016] [Accepted: 02/26/2016] [Indexed: 12/26/2022]
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Liu TC. Influence of propofol, isoflurane and enflurance on levels of serum interleukin-8 and interleukin-10 in cancer patients. Asian Pac J Cancer Prev 2015; 15:6703-7. [PMID: 25169512 DOI: 10.7314/apjcp.2014.15.16.6703] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To observe the influence of propofol, isoflurane and enflurance on interleukin-8 (IL-8) and IL-10 levels in cancer patients. METHODS Ninety cancer patients with selective operation from March 2011 to May 2014 were randomly divided into group A (34 cases), group B (28 cases) and group C (28 cases). Intramuscular injections of scopine hydrochloride and phenobarbital sodium were routinely conducted to 3 groups. After general anesthesia was induced, tracheal intubations were given. During the maintenance of anesthesia, 0.5~1.0 mg/ kg propofol was intravenously injected to group A discontinuously, while continuous suctions of isoflurane and enflurance were subsequently performed to group B and C correspondingly. Clinical outcomes, postoperative complications as well as serum IL-8 and IL-10 levels before operation (T0), at the time of skin incision (T1), 3 h after the beginning of the operation (T2) and 24 h (T3) and 72 h (T4) after the operation were observed among 3 groups. RESULTS Operations in all groups were successfully completed. The rates of surgery associated complications were 8.82% (3/34), 7.14% (2/28) and 7.14% (2/28) in group A, B and C, respectively, and there were no significant differences (P>0.05). Serum IL-8 and IL-10 levels increased gradually from the beginning of the operation and reached the peak at T3, and were evidently higher at each time point than at T0 (P<0.01). At T1, serum IL-8 and IL-10 levels had no significant differences among 3 groups (P<0.05), but the differences were significant at T2, T3 and T4 (P<0.05). Moreover, correlation analysis suggested that serum IL-8 level was in positive relation with IL-10 level (r=0.952, P<0.01). CONCLUSIONS Propofol, which is better in inhibiting serum IL-8 secretion and improving IL-10 secretion than isoflurane and enflurance, can be regarded as a preferable anesthetic agent in inhibiting traumatic inflammatory responses.
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Affiliation(s)
- Tie-Cheng Liu
- Department of Anesthesiology, The 2nd Hospital of Jilin University, Changchun, Jilin, China E-mail :
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Cassinello F, Prieto I, del Olmo M, Rivas S, Strichartz GR. Cancer surgery: how may anesthesia influence outcome? J Clin Anesth 2015; 27:262-72. [PMID: 25769963 DOI: 10.1016/j.jclinane.2015.02.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/12/2014] [Accepted: 02/17/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To review the published literature regarding the effects of anesthesia on cancer surgery to prevent tumor cell proliferation/migration or induce apoptosis. BACKGROUND Surgery is the main treatment for potentially curable solid tumors, but most cancer-related deaths in patients who have received previous surgical treatment are caused by metastatic disease. There is increasing evidence that anesthetic technique has the potential to affect long-term outcome after cancer surgery. METHODS This work reviews the English published literature that was obtained by performing a search of the PubMed database up to January 2014. We selected articles that provided evidence or reviewed the possible actions of anesthetics on cancer cells or the influence of anesthesia in recurrence/outcome. RESULTS Inhaled anesthetics induce immunosuppression and activate inflammatory cascade activation, whereas propofol has a protective action. Opioids might promote cancer recurrence and metastasis. In vitro and in vivo studies have demonstrated that local anesthetics inhibit proliferation and migration of cancer cells and induce apoptosis. CONCLUSIONS Anesthesiologists should follow current best clinical practice and include all strategies that effectively decrease pain and attenuate stress. Regional anesthesia and multimodal analgesia, adding anti-inflammatory drugs, play an unquestionable role in the control of perioperative pain and may improve recurrence-free survival.
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Affiliation(s)
| | - Isabel Prieto
- IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain.
| | - Mercedes del Olmo
- IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Sonia Rivas
- IDC-Salud Fundacion Jimenez Diaz University Hospital, 28040 Madrid, Spain
| | - Gary R Strichartz
- Pain Research Center, Department of Anesthesia. Harvard Medical School, Brigham and Women's Hospital, Boston, 02115 MA, USA
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Jones GM, Doepker BA, Erdman MJ, Kimmons LA, Elijovich L. Predictors of severe hypotension in neurocritical care patients sedated with propofol. Neurocrit Care 2014; 20:270-6. [PMID: 24233892 DOI: 10.1007/s12028-013-9902-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Propofol is used extensively in neurocritical care (NCC) due to its pharmacologic properties allowing for facilitation of serial neurologic examinations. Despite widespread use, few studies have identified risk factors for hypotension in these patients. We aimed to determine predictors of hypotension in NCC patients sedated with propofol. METHODS This retrospective, multicenter study evaluated 237 patients at two academic medical centers, both with dedicated NCC teams led by board-certified neurointensivists. Univariate analyses were performed to determine risk factors associated with severe hypotension during sedation with propofol. Multivariable analysis was performed to determine variables independently associated with hypotension, defined as a mean arterial pressure (MAP) less than 60 mmHg. RESULTS There was an average maximum reduction in MAP of 28.8 % after propofol initiation in the entire cohort. Severe hypotension developed in 62 (26.2 %) patients to a median nadir MAP of 56 mmHg. Those who developed severe hypotension had a longer median duration of mechanical ventilation (5.0 vs. 3.6 days; p = 0.01) and an increased in-hospital mortality (38.7 vs. 24.0 %; p = 0.03). Multivariable logistic regression analysis identified increasing number of changes to the propofol infusion rate, baseline MAP 60-70 mmHg, and need for renal replacement therapy (RRT) as factors independently associated with hypotension. CONCLUSIONS Multiple factors predicted hypotension in NCC patients receiving propofol. Clinicians should use propofol cautiously in patients with a lower baseline MAP or receiving RRT. Development of protocols related to the frequency of dose titrations is also recommended to prevent this avoidable complication.
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Affiliation(s)
- G Morgan Jones
- Critical Care Pharmacy, Methodist Healthcare, University Hospital, University of Tennessee Health Sciences Center, 1265 Union Avenue, Memphis, TN, 38104, USA,
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Jones GM, Doepker BA, Erdman MJ, Kimmons LA, Elijovich L. Predictors of severe hypotension in neurocritical care patients sedated with propofol. Neurocrit Care 2013. [PMID: 24233892 DOI: 10.1007/s12028-013-9902-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
INTRODUCTION Propofol is used extensively in neurocritical care (NCC) due to its pharmacologic properties allowing for facilitation of serial neurologic examinations. Despite widespread use, few studies have identified risk factors for hypotension in these patients. We aimed to determine predictors of hypotension in NCC patients sedated with propofol. METHODS This retrospective, multicenter study evaluated 237 patients at two academic medical centers, both with dedicated NCC teams led by board-certified neurointensivists. Univariate analyses were performed to determine risk factors associated with severe hypotension during sedation with propofol. Multivariable analysis was performed to determine variables independently associated with hypotension, defined as a mean arterial pressure (MAP) less than 60 mmHg. RESULTS There was an average maximum reduction in MAP of 28.8 % after propofol initiation in the entire cohort. Severe hypotension developed in 62 (26.2 %) patients to a median nadir MAP of 56 mmHg. Those who developed severe hypotension had a longer median duration of mechanical ventilation (5.0 vs. 3.6 days; p = 0.01) and an increased in-hospital mortality (38.7 vs. 24.0 %; p = 0.03). Multivariable logistic regression analysis identified increasing number of changes to the propofol infusion rate, baseline MAP 60-70 mmHg, and need for renal replacement therapy (RRT) as factors independently associated with hypotension. CONCLUSIONS Multiple factors predicted hypotension in NCC patients receiving propofol. Clinicians should use propofol cautiously in patients with a lower baseline MAP or receiving RRT. Development of protocols related to the frequency of dose titrations is also recommended to prevent this avoidable complication.
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Affiliation(s)
- G Morgan Jones
- Critical Care Pharmacy, Methodist Healthcare, University Hospital, University of Tennessee Health Sciences Center, 1265 Union Avenue, Memphis, TN, 38104, USA,
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Tang J, Jiang Y, Tang Y, Chen B, Sun X, Su L, Liu Z. Effects of propofol on damage of rat intestinal epithelial cells induced by heat stress and lipopolysaccharides. Braz J Med Biol Res 2013; 46:507-12. [PMID: 23802227 PMCID: PMC3854439 DOI: 10.1590/1414-431x20132785] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 04/19/2013] [Indexed: 11/22/2022] Open
Abstract
Gut-derived endotoxin and pathogenic bacteria have been proposed as important causative factors of morbidity and death during heat stroke. However, it is still unclear what kind of damage is induced by heat stress. In this study, the rat intestinal epithelial cell line (IEC-6) was treated with heat stress or a combination of heat stress and lipopolysaccharide (LPS). In addition, propofol, which plays an important role in anti-inflammation and organ protection, was applied to study its effects on cellular viability and apoptosis. Heat stress, LPS, or heat stress combined with LPS stimulation can all cause intestinal epithelial cell damage, including early apoptosis and subsequent necrosis. However, propofol can alleviate injuries caused by heat stress, LPS, or the combination of heat stress and LPS. Interestingly, propofol can only mitigate LPS-induced intestinal epithelial cell apoptosis, and has no protective role in heat-stress-induced apoptosis. This study developed a model that can mimic the intestinal heat stress environment. It demonstrates the effects on intestinal epithelial cell damage, and indicated that propofol could be used as a therapeutic drug for the treatment of heat-stress-induced intestinal injuries.
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Affiliation(s)
- J Tang
- Southern Medical University, Nanfang Hospital, Department of Anesthesia, Guangzhou, China, Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Tang J, Deng P, Jiang Y, Tang Y, Chen B, Su L, Liu Z. Role of HMGB1 in propofol protection of rat intestinal epithelial cells injured by heat shock. Cell Biol Int 2013; 37:262-6. [PMID: 23364923 DOI: 10.1002/cbin.10040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/23/2012] [Indexed: 12/16/2022]
Abstract
Gut-derived endotoxin and pathogenic bacteria may be important causative factors of morbidity and death during heat stroke. However, as the key component of intestinal mucosal barrier, the molecular mechanism of how intestinal epithelial cells are injured by heat shock is remains unclear. After rat intestinal epithelial cells (IEC-6) had been exposed to heat shock, their viability was measured. Propofol, which plays an important role in anti-inflammation and organ protection, was investigated to see how it affected viability under this stress. Changes of high mobility group box 1 (HMGB1) in IEC-6 cells were measured with RT-PCR and Western blot assay at transcription and translational levels, respectively. Ethyl pyruvate (EP), a specific inhibitor of HMGB1 that can inhibit the release of HMGB1 without affecting its intracellular synthesis, was also investigated. Heat shock significantly reduced the intracellular level of HMGB1, and propofol inhibit its reduction. Propofol protected the heat shock-injured cells, at least partly through inhibiting the release of intracellular HMGB1 to reduce the direct or indirect cell damage caused by HMGB1. Pretreatment with high concentrations of EP also attenuated heat-shock injury.
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Affiliation(s)
- Jing Tang
- Department of Anesthesia, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
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Abstract
BACKGROUND Propofol is an intravenous anesthetic that is widely used to anesthetize patients during neurosurgical procedures. Although propofol is considered to be an essential component of contemporary management of acute brain injury in the operating room and in critical care settings, propofol-induced hypotension (PIH) remains a frequent and undesirable side effect. After 3 decades of clinical use, multiple proposed causes of PIH, and conflicting experimental results, the mechanism of PIH is still a puzzle for neuroscience and anesthesiology. This study evaluated the role of opioid receptors in PIH. METHODS Pentobarbital-anesthetized rats were subjected to systemic or central pretreatment with naloxone followed by intravenous or central administration of propofol. RESULTS In the absence of pretreatment with naloxone, intravenous (7.5 mg/kg) and intracistenal propofol (10 µg) injection induced 45% and 35% reductions in the mean arterial pressure, respectively (P<0.05). Both systemic (5 mg/kg) and central (100 µg) pretreatment with naloxone prevented PIH without independently affecting mean arterial pressure. CONCLUSIONS This experiment in anesthetized rats indicates that central and peripheral opioid receptor blockade prevents PIH, suggesting that these receptors are involved in the cardiovascular alterations elicited by propofol administration.
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Sweni S, Meenakshisundaram R, Senthilkumaran S, Thirumalaikolundusubramanian P. Propofol’s derivative: A potential drug for erectile dysfunction? Med Hypotheses 2011; 77:668-70. [DOI: 10.1016/j.mehy.2011.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 07/04/2011] [Indexed: 11/17/2022]
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Promotion of interferon-gamma production by natural killer cells via suppression of murine peritoneal macrophage prostaglandin E2 production using intravenous anesthetic propofol. Int Immunopharmacol 2010; 10:1200-8. [DOI: 10.1016/j.intimp.2010.06.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/10/2010] [Accepted: 06/26/2010] [Indexed: 01/24/2023]
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Wessely-Szponder J, Szponder T. Comparison of the effects of two anaesthetic combinations in rabbits on some neutrophil functions in vitro. WORLD RABBIT SCIENCE 2010. [DOI: 10.4995/wrs.2010.8414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Turek Z, Sykora R, Matejovic M, Cerny V. Anesthesia and the Microcirculation. Semin Cardiothorac Vasc Anesth 2009; 13:249-58. [DOI: 10.1177/1089253209353134] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is increasing evidence that the microcirculation and its regulation are severely compromised during many pathological conditions, such as hemorrhage, sepsis, or trauma. The effects of anesthetic agents on macrohemodynamics were investigated intensively in the last several decades. Research regarding modern anesthetics and anesthesia techniques has increased knowledge regarding the nonanesthetic effects of anesthetic agents, including those on organ perfusion and the microcirculation. Alterations in microvascular reactivity, nitric oxide pathways, and cytokine release are presumably the main mechanisms of anesthetic-induced tissue perfusion changes. This review summarizes current methods of microcirculatory status assessment and current knowledge regarding the microcirculatory effects of intravenous and potent volatile anesthetics and anesthesia-related techniques under both normal and pathophysiological conditions.
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Affiliation(s)
- Zdenek Turek
- University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic,
| | - Roman Sykora
- Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic, Department of Anesthesiology and Intensive Care, Hospital Karlovy Vary, Czech Republic
| | - Martin Matejovic
- Charles University in Prague, Faculty of Medicine in Pilsen, Czech Republic, University Affiliated Hospital Plzen
| | - Vladimir Cerny
- University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
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Vasileiou I, Xanthos T, Koudouna E, Perrea D, Klonaris C, Katsargyris A, Papadimitriou L. Propofol: A review of its non-anaesthetic effects. Eur J Pharmacol 2009; 605:1-8. [DOI: 10.1016/j.ejphar.2009.01.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kambara T, Inada T, Kubo K, Shingu K. Propofol Suppresses Prostaglandin E2Production in Human Peripheral Monocytes. Immunopharmacol Immunotoxicol 2009; 31:117-26. [DOI: 10.1080/08923970802452046] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Inada T, Kubo K, Kambara T, Shingu K. Propofol inhibits cyclo-oxygenase activity in human monocytic THP-1 cells. Can J Anaesth 2009; 56:222-9. [PMID: 19247743 DOI: 10.1007/s12630-008-9035-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 11/26/2008] [Accepted: 12/09/2008] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Monocytes/macrophages are key players in innate and adaptive immunity. Upon stimulation, they secrete prostanoids, which are produced by cyclooxygenase from arachidonic acid. Prostanoids influence inflammation and immune responses. We investigated the effect of propofol on prostaglandin E(2) and thromboxane B(2) production by the human monocytic cell line THP-1. METHODS The THP-1 cells were cultured with lipopolysaccharide (1 microg ml(-1)) in the presence of clinically relevant sedative/anesthetic concentrations of propofol (0-30 microM) for 18 h, and the concentration of prostaglandin E(2) and thromboxane B(2) in culture supernatants was measured using an enzyme immunoassay. Intracellular cyclooxygenase protein expression was measured by flow cytometry. Cyclooxygenase activity was assessed by measuring production of prostaglandin E(2) and thromboxane B(2) by THP-1 cells after arachidonic acid (10 microM) substrate provision. RESULTS Propofol decreased the production of prostaglandin E(2) (75.4 +/- 6.4 pg ml(-1) at 0 microM vs. 28.5 +/- 11.2 pg ml(-1) at 30 microM; P < 0.001) and thromboxane B(2) (282.4 +/- 79.2 pg ml(-1) at 0 microM vs. 40.4 +/- 21.7 pg ml(-1) at 30 microM; P < 0.001). The inhibition was not due to the decreased cyclooxygenase protein expression because intracellular staining of this enzyme was not affected by propofol. After arachidonic acid provision, prostaglandin E(2) and thromboxane B(2) production from activated THP-1 cells was significantly (P < 0.001) decreased with propofol, indicating direct suppression of cyclooxygenase activity with propofol. CONCLUSIONS Propofol may modulate inflammation via the suppression of cyclooxygenase activity. Through the inhibition of prostanoid production, propofol may enhance immune responses.
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Affiliation(s)
- Takefumi Inada
- Department of Anesthesiology, Kansai Medical University, 10-15, Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
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