Gas chromatographic headspace analysis of sevoflurane in blood

Potentiation of GABAA receptor activity by volatile anaesthetics is reduced by α5GABAA receptor-preferring inverse agonists

BACKGROUND

Animal studies have shown that memory deficits in the early post-anaesthetic period can be prevented by pre-treatment with an inverse agonist that preferentially inhibits α5 subunit-containing γ-aminobutyric acid type A (α5GABA(A)) receptors. The goal of this in vitro study was to determine whether inverse agonists that inhibit α5GABA(A) receptors reduce anaesthetic potentiation of GABAA receptor activity.

METHODS

Cultures of hippocampal neurones were prepared from Swiss white mice, wild-type mice (genetic background C57BL/6J and Sv129Ev) and α5GABA(A)receptor null mutant (Gabra5-/-) mice. Whole-cell voltage clamp techniques were used to study the effects of the α5GABA(A) receptor-preferring inverse agonists L-655,708 and MRK-016 on anaesthetic potentiation of GABA-evoked currents.

RESULTS

L-655,708 (50 nM) reduced sevoflurane potentiation of GABA-evoked current in wild-type neurones but not Gabra5-/- neurones, and produced a rightward shift in the sevoflurane concentration-response plot [sevoflurane EC50: 1.9 (0.1) mM; sevoflurane+L-655,708 EC(50): 2.4 (0.2) mM, P<0.05]. Similarly, L-655,708 (50 nM) reduced isoflurane potentiation of GABA-evoked current [isoflurane: 4.0 (0.6) pA pF(-1); isoflurane+L-655,708: 3.1 (0.5) pA pF(-1), P<0.01]. MRK-016 also reduced sevoflurane and isoflurane enhancement of GABA-evoked current [sevoflurane: 1.5 (0.1) pA pF(-1); sevoflurane+MRK-016 (10 nM): 1.2 (0.1) pA pF(-1), P<0.05; isoflurane: 3.5 (0.3) pA pF(-1); isoflurane+MRK-016 (1 nM): 2.9 (0.2) pA pF(-1), P<0.05].

CONCLUSIONS

L-655,708 and MRK-016 reduced the potentiation by inhaled anaesthetics of GABAA receptor activated by a low concentration of GABA. Future studies are required to determine whether this effect contributes to the memory preserving properties of inverse agonists after anaesthesia.

Sevoflurane binds and allosterically blocks integrin lymphocyte function-associated antigen-1

BACKGROUND

Volatile anesthetics have been shown to modify immune cell functions via several mechanisms, some of which have been only partially elucidated. We demonstrated that isoflurane inhibits primary leukocyte integrin lymphocyte function-associated antigen-1 (LFA-1) by binding to the allosteric cavity critical for conformational activation to its high-affinity form. It remains to be determined whether the allosteric inhibition of LFA-1 by isoflurane can be generalized to other anesthetics such as sevoflurane.

METHODS

The effects of sevoflurane on the ability of LFA-1 to bind to its counter-ligand, intercellular adhesion molecule-1, was studied in leukocytes by flow cytometry. To examine whether sevoflurane acts directly on LFA-1, we measured ligand-binding using beads coated with purified LFA-1 protein. To distinguish between competitive versus allosteric inhibition, we analyzed the effects of sevoflurane on both wild-type and mutant-locked high-affinity LFA-1. One-way analysis of variance was employed for statistical analysis of the data. Nuclear magnetic resonance spectroscopy was used to identify sevoflurane binding site(s).

RESULTS

Sevoflurane at clinically relevant concentrations inhibited the ligand-binding function of LFA-1 in leukocytes as well as in cell-free assays (P<0.05). Sevoflurane blocked wild-type but not locked high-affinity LFA-1, thereby demonstrating an allosteric mode of inhibition. Nuclear magnetic resonance spectroscopy revealed that sevoflurane bound to the allosteric cavity, to which LFA-1 allosteric antagonists and isoflurane also bind.

CONCLUSIONS

This study suggests that sevoflurane also blocks the activation-dependent conformational changes of LFA-1 to the high-affinity form. The allosteric mode of action exemplified by sevoflurane and isoflurane via LFA-1 might represent one of the underlying mechanisms of anesthetic-mediated immunomodulation.

Sevoflurane depolarizes pre-synaptic mitochondria in the central nervous system

BACKGROUND

Volatile anaesthetics protect the heart from ischaemic injury by activating mitochondrial signalling pathways. The aim of this study was to test whether sevoflurane, which is increasingly used in neuroanaesthesia, affects mitochondrial function in the central nervous system by altering the mitochondrial membrane potential (DeltaPsi(m)).

METHODS

In order to correlate free cytosolic Ca(2+) ([Ca(2+)](i)) and DeltaPsi(m), rat neural presynaptic terminals (synaptosomes) were loaded with the fluorescent probes fura-2 and JC-1. During sevoflurane exposure, 4-aminopyridine (4-AP) 500 micro M to induce pre-synaptic membrane depolarization or carbonylcyanide-p-(trifluoromethoxy)-phenylhydrazone (FCCP) 1 micro M to induce maximum mitochondrial depolarization was added. In order to block mitochondrial ATP-regulated K(+)-channels (mitoK(ATP)), the antagonist 5-hydroxydecanoate (5-HD) 500 micro M was added.

RESULTS

In Ca(2+)-containing medium, both sevoflurane 1 and 2 MAC gradually decreased the normalized JC-1 ratio from 0.96 +/- 0.01 in control to 0.92 +/- 0.01 and 0.89 +/- 0.01, representing a depolarization of DeltaPsi(m) (n = 9, P < 0.05). Sevoflurane 2 MAC increased [Ca(2+)](i). In Ca(2+)-depleted medium, sevoflurane 1 and 2 MAC depolarized DeltaPsi(m), while [Ca(2+)](i) remained unaltered. Sevoflurane 2 MAC attenuated the 4-AP-induced depolarization of DeltaPsi(m). When mitoK(ATP) was blocked, the sevoflurane-induced depolarization of DeltaPsi(m) was attenuated, but not blocked. The depolarizing effect of sevoflurane on DeltaPsi(m) compared with FCCP was calculated to 13.2 +/- 1.3% in Ca(2+)-containing and 15.1 +/- 1.2% in Ca(2+)-depleted medium (n = 7).

CONCLUSIONS

Sevoflurane depolarizes DeltaPsi(m) in rat synaptosomes, and the effect is not dependent on Ca(2+)-influx to the cytosol. Opening of mitoK(ATP) is partly responsible for the depolarizing effect of sevoflurane.

The effect of isoflurane and sevoflurane on cerebrocortical presynaptic Ca2+ and protein kinase C activity

Protein kinase C (PKC) is an important enzyme involved in the regulation of neurotransmission and might also be important in the mediation of ischemic neuronal death. PKC has been implicated as a target of volatile anesthetics as well as in anesthetic protection against ischemia. The present study tested the effect of isoflurane and sevoflurane, both used in neuroanesthetic practice, on presynaptic free cytosolic Ca2+ ([Ca2+](i)) and PKC activity. To measure [Ca2+](i) and PKC activation simultaneously, rat synaptosomes, mostly containing presynaptic terminals, were loaded with the fluorescent probes fura-2 and fim-1, respectively. The synaptosomes were exposed to either isoflurane or sevoflurane in concentrations corresponding to 1 and 2 MAC values in rats, both in Ca2+-containing and Ca2+-free medium. After 8 minutes of anesthetic exposure, 1 mM 4-aminopyridine was added to induce membrane depolarization. Isoflurane 1 and 2 MAC increased the basal PKC activity after 8 minutes in Ca2+-containing medium by 15.1% (3.6%) and 30.5% (5.5%) compared with control, respectively [mean (SEM); n = 9, both values P < 0.05]. Sevoflurane 2 MAC transiently decreased but thereafter increased the PKC activity (P < 0.05). In Ca2+ -free medium sevoflurane attenuated the PKC activity (P < 0.05). The anesthetics did not alter the depolarization-evoked enzyme activation. Furthermore, 2 MAC of both isoflurane and sevoflurane increased the basal- and attenuated the depolarization-evoked increase in [Ca2+](i) (P < 0.05). The present study supports the hypotheses that volatile anesthetics affect presynaptic PKC activity and that the anesthetic effect on enzyme activation seems to be related to an increase in [Ca2+](i).

A closed chamber method for performing biochemical experiments at accurate concentrations of volatile agents

Experiments with volatile agents such as general anesthetics present difficulties in maintaining defined concentrations of these agents during in-vitro experimental conditions. In conventional filtration apparatuses, due to their partition between liquid and vapor phases (to open air or headspaces of the incubation vehicles), some degree of inaccuracy in calculated concentrations of these agents may occur in experiments using these types of chambers. In the present study, a method is described which permits the performance of biochemical experiments in a closed system in which the concentrations of a volatile agent, desflurane, in the liquid phase of the assay environment can be maintained constant for a relatively long time period.

Enflurane as an internal standard in monitoring halogenated volatile anaesthetics by headspace gas chromatography-mass spectrometry

Recently. we proposed the use of a run-only headspace-GC-MS method for the biological monitoring of ppb concentrations of unmodified volatile anaesthetics (isoflurane, sevoflurane and halothane, plus nitrous oxide) in post-shift urine of operating theatre personnel. The adoption of enflurane (a volatile anaesthetic no longer used in clinical practice) as a poper and viable internal standard improves intra-day and inter-day accuracy in halide quantitation, providing a GC-MS reference method useful in the practice of biomonitoring of exposure of operating theatre personnel to modern volatile anaesthetics (isoflurane. sevoflurane, halothane).

Sensitive determination of four general anaesthetics in human whole blood by capillary gas chromatography with cryogenic oven trapping

Four general anaesthetics, sevoflurane, isoflurane, enflurane and halothane, in human whole blood, have been found measurable with very high sensitivity by capillary gas chromatography-flame ionization detection (GC-FID) with cryogenic oven trapping upon injection of headspace (HS) vapor sample. To a 7-ml vial, containing 0.48 ml of distilled water and 20 microl of internal standard solution (5 microg), a 0.5-ml of whole blood sample spiked with or without anaesthetics, was added, and the mixture was heated at 55 degrees C for 15 min. A measure of 10 ml HS vapor was injected into the GC in the splitless mode at -40 degrees C oven temperature, which was programmed up to 250 degrees C. All four peaks were clearly separated; no impurity peaks were found among their peaks. Their extraction efficiencies were about 10%. The calibration curves showed good linearity in the range of 0.5-20 microg/ml; their detection limits were 10-100 ng/ml, which are almost comparable to those by previous reports. The coefficients of intra-day and day-to-day variations were 6.5-9.8 and 7.3-17.2%, respectively. Isoflurane or enflurane was also measured from whole blood samples in which three volunteers inhaled each compound.

Simultaneous determination of fluorinated inhalation anesthetics in blood by gas chromatography-mass spectrometry combined with a headspace autosampler

Although the fluorinated inhalation anesthetics, including desflurane, sevoflurane, isoflurane, enflurane, and halothane are commonly used, fatal cases resulting from their abuse or misuse have been reported. To date, gas chromatography (GC) equipped with different kinds of detectors has been utilized to analyze inhalation anesthetics. However, none of them can detect desflurane reliably or analyze all five common anesthetics simultaneously. The purpose of the present work is to further modify the previously developed headspace (HS) GC-MS method for blood isoflurane determination to analyze and distinguish five common clinical inhalation anesthetics, simultaneously. The modified HS-GC-MS method adopts a 60 m x 0.25 mm I.D., 0.25 microm film thickness DB-5 capillary column along with an adequate GC temperature program, which gives the five inhalation anesthetics, including isoflurane and its isomer, enflurane, a high resolution. The method also takes both the volatility and the influence of the top space on the obtained concentration into consideration and therefore keeps the sample loss acceptable even for analyzing the highly volatile desflurane. Within a certain concentration range of the calibration standard (about 20-300 microg/ml), this method shows a good linearity with correlation coefficients greater than 0.999. In addition, both within- and between-run precision and accuracy results meet the validation requirements as well as the tested results of practical blood samples of desflurane. In summary, this is a reliable analytical method to simultaneously determine the concentration of five common inhalation anesthetics in blood. Such a method is very practical for both clinical and occupational monitoring, as well as for analytical toxicology.

Reliable gas chromatographic-mass spectrometric method combined with a headspace autosampler for isoflurane determination in blood

Isoflurane is a nonflammable, liquid, volatile inhalation anesthetic administered by vaporizing. Although it is now commonly used, fatal cases resulting from its abuse or misuse have been reported. A combined system of a gas chromatograph-mass spectrometer and a headspace autosampler is therefore proposed for the detection of blood isoflurane. This analytic method showed sharp and well separated peaks, and revealed a good linear relationship (r=0.9994) with a function of y = 7.3768x - 0.0222 at concentrations between 18.7 and 299.2 microg/ml. The limits of detection and quantitation of this method were 1.2 and 4.7 microg/ml, respectively. The within- and between-run precision for spiked samples, assessed by the coefficient of variations, ranged from 1.7 to 10.0% and from 4.1 to 12.8%, respectively. The within- and between-run accuracy, assessed by errors from theoretical values, were 2.2-7.8% and 2.4-9.6%, respectively. In addition, practical sample analysis showed a good applicability, with a within-run precision rate of 5.6 to 7.7% and a between-run precision rate of 5.2-10.6%. In summary, the present work presents a valid alternative for blood isoflurane analysis.

Analytical toxicology of fluorinated inhalation anaesthetics

The chemical and pharmacological properties of the current fluorinated inhalation anaesthetics, halothane, enflurane, isoflurane, sevoflurane and desflurane, are surveyed with implications to toxicity. Analytical methods, especially gas chromatography with head space, purge and trap, or pulse heating extraction, are reviewed in forensic toxicological and occupational/therapeutic monitoring contexts.

Actions of general anaesthetics and arachidonic pathway inhibitors on K+ currents activated by volatile anaesthetics and FMRFamide in molluscan neurones

1. K+ currents activated by volatile general anaesthetics (IK(An)) and by the neuropeptide FMRFamide (IK(FMRFa)) were studied under voltage clamp in isolated identified neurones from the pond snail Lymnaea stagnalis. 2. IK(An) was activated by all the volatile anaesthetics studied. The maximal responses varied from agent to agent, with halothane sevoflurane > isoflurane > enflurane approximately chloroform. 3. IK(An) was inhibited rather than activated by the n-alcohols from hexanol to dodecanol and by the 6- and 8-carbon cycloalcohols. The n-alcohols exhibited a cutoff effect, with dodecanol being unable to half-inhibit IK(An). 4. Unlike IK(An) which did not desensitize at reasonable halothane concentrations, IK(FMRFa) desensitized at most FMRFamide concentrations studied. This desensitization could be substantially removed by halothane. Nonetheless, both IK(An) and IK(FMRFa) had similar sensitivities to the potassium channel blockers tetraethylammonium and 4-aminopyridine, consistent with both currents flowing through the same channels. Responses to low concentrations of halothane and FMRFamide showed synergy. 5. The phospholipase A2 inhibitor aristolochic acid inhibited IK(An), consistent with a role for arachidonic acid (AA). The lipoxygenase and cyclooxygenase inhibitor nordihydroguaiaretic acid blocked IK(FMRFa) but did not affect IK(An). IK(An) and IK(FMRFa) were little affected by the cyclooxygenase inhibitor indomethacin. These findings suggest that neither lipoxygenase nor cyclooxygenase pathways of AA metabolism are involved in the anaesthetic activation of IK(An. 6. Inhibitors of a third, cytochrome P450-mediated, pathway of AA metabolism (clotrimazole and econazole) potently blocked IK(An), suggesting possible roles for certain cytochrome P450 isoforms in the activation of IK(An).

Kinetics of sevoflurane action on GABA- and glycine-induced currents in acutely dissociated rat hippocampal neurons

Effects of a new kind of volatile anaesthetics, sevoflurane, on GABA- and glycine-gated chloride current (ICl) were examined in single pyramidal neurons acutely dissociated from the rat hippocampal CA1 region, using the voltage-clamp mode of the nystatin-perforated patch-clamp technique. Rapid application of sevoflurane-induced ICl by itself, with the time to peak reduced as the sevoflurane concentration was increased from 10(-3) to 3 x 10(-3) M. Although a pretreatment with 10(-3) M sevoflurane enhanced the peak amplitude of GABA (3 x 10(-6) M)-induced ICl and suppressed the peak amplitude when the GABA concentration was increased to 10(-4) M, the pretreatment decreased the time to peak of the ICl induced by any concentration of GABA (from 3 x 10(-6) to 10(-4) M). The treatment also accelerated the decay phase of the GABA-induced ICl. On the other hand, sevoflurane suppressed the peak ICl induced by 3 x 10(-5) M glycine in a concentration-dependent manner. In the presence of 3 x 10(-4) M sevoflurane, the peak amplitude of the glycine-induced ICl was decreased without changes in EC50 or Hill coefficients. Pretreatment with 10(-3) M sevoflurane did not affect the time to peak of the ICl induced by any concentration of glycine (from 3 x 10(-5) to 10(-3) M). Pretreatment with 3 x 10(-8) M strychnine markedly prolonged the time to peak of the glycine-induced ICl. These results suggest that sevoflurane modulated the amplitude of the GABA responses, depending on the balance of the accelerated activation and decay phases, and that sevoflurane suppressed the glycine-induced ICl in a non-competitive manner without noticeable effect on the kinetics. The reversible and differential modulation of GABA(A) and glycine receptors might underlie a part of the anaesthetic actions and less adverse clinical effects of sevoflurane.

Effects of volatile anesthetics on the calcium ionophore A23187-mediated alterations in hepatic flow and metabolism in the perfused liver in fasted rats

Alterations in intracellular calcium homeostasis have been implicated in heptic injury. Volatile anesthetics modulate the homeostasis of intracellular calcium. The effects of volatile anesthetics on the hemodynamic and metabolic alterations induced by the calcium ionophore A23187 were studied using isolated liver perfusion in fasted rats. The liver was isolated from 24 hr-fasted male Sprague-Dawley rats, and perfused through the portal vein at a constant pressure of 1.2 kPa in a recirculating perfusion-aeration system. Halothane, isoflurane and sevoflurane were administered at 2%, 3% and 4.4%, respectively. All volatile anesthetics maintained basal hepatic flow, reduced oxygen consumption, and transiently enhanced net lactate production. A23187 at initial concentrations of 0.8 to 3.2 microM decreased hepatic flow and oxygen consumption in a dose-dependent manner, and enhanced lactate production. All anesthetics significantly attenuated the decreases in hepatic flow and oxygen consumption after administration of A23187 at 1.6 microM. None of the anesthetics significantly influenced the A23187-induced enhancement of net lactate production. Volatile anesthetics may attenuate the hepatic vasoconstriction and oxygen debt induced by intracellular calcium overload.

Effects of halothane, isoflurane and sevoflurane on ischemia-reperfusion injury in the perfused liver of fasted rats

BACKGROUND

Although intraoperative ischemia-reperfusion of the liver generally occurs under general anesthesia, little is known about the direct effect of anesthetic agents on hepatic injury due to this phenomenon. The effect of volatile anesthetics on ischemia-reperfusion injury was studied using isolated liver perfusion.

METHODS

The liver was isolated from 24-h-fasted male Sprague-Dawley rats and perfused through the portal vein with a modified Krebs-Ringer bicarbonate solution in a recirculating perfusion-aeration system. Ischemia was induced by reducing the baseline perfusion pressure from 1.2 to 0.2 kPa followed by reperfusion to baseline level. The ischemia-reperfusion injury was assessed by LDH release from the perfused liver. We studied the effect of halothane, isoflurane and sevoflurane on the ischemia-reperfusion injury during 20 min of control conditions, exposure of the liver to 60 min of ischemia and reperfusion for 90 min.

RESULTS

Ischemia was evident by reduced portal vein flow and oxygen consumption, and caused an increase in lactate production. Reperfusion caused a transient reduction in lactate production and a significant increase in LDH release. All anesthetics reduced hepatic oxygen consumption and increased the net lactate production during control conditions. Volatile anesthetics also significantly attenuated LDH release during reperfusion. The suppression of LDH release was observed even when isoflurane was administered during the reperfusion period, but not when it was administered only during ischemia.

CONCLUSION

These results indicate that volatile anesthetics may protect the fasted liver from early, neutrophil-independent, ischemia-reperfusion injury by acting during the reperfusion phase.

Effects of inhalational general anaesthetics on native glycine receptors in rat medullary neurones and recombinant glycine receptors in Xenopus oocytes

1. Glycine responses were studied under voltage clamp in Xenopus oocytes injected with cDNA encoding mammalian glycine receptor subunits and in rat medullary neurones. Bath application of glycine gave strychnine-sensitive currents which reversed close to the expected equilibrium potentials for chloride ions. The peak currents for the receptors expressed in oocytes fitted a Hill equation with EC50 = 215 +/- 5 microM and Hill coefficient nH = 1.70 +/- 0.05 (means +/- s.e. means). The peak currents from the receptors in medullary neurones fitted a Hill equation with EC50 = 30 +/- 1 microM and Hill coefficient nH = 1.76 +/- 0.08. The current-voltage relationship for the receptors expressed in oocytes showed strong outward rectification (with Vrev = -21 +/- 2 mV), while that for the glycine responses from the medullary neurones in symmetrical Cl- was linear (with Vrev = 3.2 +/- 0.6 mV). 2. Inhalational general anaesthetics, at concentrations close to their human minimum alveolar concentrations (MACs), potentiated responses to low concentrations of glycine. The potentiation observed with the recombinant receptors (between 60-22%) was approximately twice that found with the medullary neurones (between 40-80%). For both the recombinant receptors and the receptors in medullary neurones, the degree of potentiation increased in the order of methoxyflurane approximately sevoflurane < halothane approximately isoflurane approximately enflurane. There was no significant difference between the potentiations observed for the two optical isomers of isoflurane. 3. For both the recombinant and native receptors, isoflurane potentiated the currents in a dose-dependent manner at low concentrations of glycine, although at high glycine concentrations the anaesthetic had no significant effect on the glycine-activated responses. The major effect of isoflurane was to cause a parallel leftward shift in the glycine concentration-response curves. The glycine EC50 concentration for the recombinant receptors decreased from a control value of 215 +/- 5 microM to 84 +/- 7 microM glycine at 610 microM isoflurane, while that for the medullary neurones decreased from a control value of 30 +/- 1 microM to 18 +/- 2 microM glycine at the same concentration of isoflurane. The potentiation was independent of membrane potential. 4. Isoflurane also potentiated responses to taurine, a partial agonist at the glycine receptor. This was observed for receptors expressed in oocytes at both low and saturating concentrations of taurine. The EC50 concentration decreased from a control value of 1.6 +/- 0.2 to 0.9 +/- 0.1 mM taurine in the presence of 305 microM isoflurane, while the maximum response to taurine increased from 47 +/- 2 to 59 +/- 2% of the maximum response to glycine. 5. Glycine receptors, like other members of the fast ligand-gated receptor superfamily, are sensitive to clinically relevant concentrations of inhalational general anaesthetics. Effects at these receptors may, therefore, play some role in the maintenance of the anaesthetic state.

The quantitative analysis of inhalational anaesthetics in forensic samples by gas chromatography/mass spectrometry/selected ion monitoring

The quantitative analysis of volatile anaesthetics for biomedical applications by means of gas chromatograph/mass spectrometry/selected ion monitoring (GC/MS/SIM) was studied. Xenon gas was selected as an internal standard for the assay by adding to a closed system, because of its stability and inactivity. In the assay of inhalational anaesthetics, isoflurane and nitrous oxide (laughing gas), in forensic samples (serum and cerebrospinal fluid), the calibration of the anaesthetic was linear from 0.12 to 12 nmol/mL in isoflurane and from 30 to 300 nmol/mL in nitrous oxide. Our results suggest that this new method is suitable for the quantitative analysis of inhalational anaesthetics in the biomedical field.

Analysis of sevoflurane degradation products in vapor phase samples

Sevoflurane degradation products were measured by GC-flame ionization detection in vapor phase samples using manual and automated injection methods. Sample handling techniques allowed the transfer and storage of samples for up to 72 h. Compound A, fluoromethyl 2,2-difluoro-1-(trifluoromethyl)vinyl ether, was the major vapor phase degradation product formed in simulated clinical conditions. Recoveries of 4-32 ppm (v/v) compound A concentrations using the manual method were in the range of 88-117% (n = 12, mean = 102%, R.S.D. = 9%).