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Zhou Y, Dong W, Qiu YK, Shao KJ, Zhang ZX, Yao JQ, Chen TQ, Li ZY, Zhou CR, Jiao XH, Chen Y, Lu H, Wu YQ. Regulating the activity of GABAergic neurons in the ventral pallidum alters the general anesthesia effect of propofol. Neuropharmacology 2024; 257:110032. [PMID: 38852839 DOI: 10.1016/j.neuropharm.2024.110032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/28/2024] [Accepted: 06/06/2024] [Indexed: 06/11/2024]
Abstract
The full mechanism of action of propofol, a commonly administered intravenous anesthetic drug in clinical practice, remains elusive. The focus of this study was the role of GABAergic neurons which are the main neuron group in the ventral pallidum (VP) closely associated with anesthetic effects in propofol anesthesia. The activity of VP GABAergic neurons following propofol anesthesia in Vgat-Cre mice was observed via detecting c-Fos immunoreactivity by immunofluorescence and western blotting. Subsequently, chemogenetic techniques were employed in Vgat-Cre mice to regulate the activity of VP GABAergic neurons. The role of VP GABAergic neurons in generating the effects of general anesthesia induced by intravenous propofol was further explored through behavioral tests of the righting reflex. The results revealed that c-Fos expression in VP GABAergic neurons in Vgat-Cre mice dramatically decreased after propofol injection. Further studies demonstrated that chemogenetic activation of VP GABAergic neurons during propofol anesthesia shortened the duration of anesthesia and promoted wakefulness. Conversely, the inhibition of VP GABAergic neurons extended the duration of anesthesia and facilitated the effects of anesthesia. The results obtained in this study suggested that regulating the activity of GABAergic neurons in the ventral pallidum altered the effect of propofol on general anesthesia.
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Affiliation(s)
- Yue Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Wei Dong
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yong-Kang Qiu
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Ke-Jie Shao
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Zi-Xin Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Jia-Qi Yao
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Tian-Qi Chen
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Zi-Yi Li
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Chen-Rui Zhou
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Xin-Hao Jiao
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China
| | - Yu Chen
- Department of Anesthesiology, Liyang People's Hospital, Jiangsu Province, Liyang, China; Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Han Lu
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu-Qing Wu
- Jiangsu Province Key Laboratory of Anesthesiology, NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, China.
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Gao X, Yang X, Tang Y, Fang X, Yuan Y, Qi H, Li R, Shu H, Zou X, Shang Y. Fospropofol disodium versus propofol for long-term sedation during invasive mechanical ventilation: A pilot randomized clinical trial. J Clin Anesth 2024; 95:111442. [PMID: 38493706 DOI: 10.1016/j.jclinane.2024.111442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
STUDY OBJECTIVE Fospropofol disodium is a propofol prodrug that is water-soluble and has a reduced risk of bacterial contamination and hypertriglyceridemia compared with propofol. Prior to implementing a large randomized trial, we investigated the feasibility, initial efficacy, and safety of fospropofol disodium compared with propofol in long-term mild-to-moderate sedation in intensive care units (ICUs). DESIGN Single-centered, prospective, unblind, randomized, parallel-group clinical trial. SETTING The general ICU of university-affiliated teaching hospital. PATIENTS Adult patients (n = 60) expected to have mechanical ventilation for >24 h were enrolled and randomly assigned to the fospropofol or propofol group. INTERVENTIONS The fospropofol group received continuous fospropofol disodium infusions and the propofol group received continuous propofol infusions. The sedation goal was a score of -3 to 0 on the Richmond Agitation and Sedation Scale (RASS). MEASUREMENTS The primary outcome was the percentage of time spent in the target sedation range without rescue sedation. Safety outcomes were based on adverse events. Blood samples were collected to measure formate concentration in plasma. MAIN RESULTS The median dose was 4.33 (IQR, 3.08-4.94) mg/kg/h in the fospropofol group and 1.96 (IQR, 1.44-2.94) mg/kg/h in the propofol group. The median percentage of time spent in the target RASS range without rescue sedation was identical in both groups, with 83.33% (IQR, 74.43%-100.00%) in the fospropofol group and 83.33% (IQR, 77.45%-100.00%) in the propofol group (p = 0.887). At least one adverse event was identifed in 23 (76.7%) fospropofol patients and 27 (90.0%) propofol patients. The most common adverse events were tachycardia and hypotension. No paresthesia, catheter-related bloodstream infection or propofol infusion syndrome in both groups was reported. Three patients in the fospropofol group had mild hypertriglyceridemia, and nine patients in propofol group had hypertriglyceridemia (mild in eight patients and moderate in one patient) (10% versus 30%, p = 0.104). The formate concentration in plasma was very low, and no significant difference was identified at any time point between the two groups. CONCLUSIONS Fospropofol disodium appears to be a feasible, effective and safe sedative for patients receiving invasive mechanical ventilation with long-term sedation.
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Affiliation(s)
- Xuehui Gao
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaobo Yang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yun Tang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiangzhi Fang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yin Yuan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hong Qi
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruiting Li
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huaqing Shu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojing Zou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Sato S, Yamano Y, Kanno C, Maeda Y, Takahashi F. Cardiopulmonary function, anesthetic effects, quality of arousal, hematology, and blood biochemistry during continuous intravenous infusion of a combination solution of xylazine, butorphanol, and propofol in calves. Vet Res Commun 2024; 48:2295-2308. [PMID: 38748076 DOI: 10.1007/s11259-024-10404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/01/2024] [Indexed: 08/10/2024]
Abstract
General anesthesia in calves is easier to perform under field conditions, total intravenous anesthesia (TIVA) than using inhalation anesthesia. In the present study, cardiopulmonary function, anesthetic effects, quality of arousal, hematology, and blood biochemistry were assessed during continuous infusion of a combination solution of 0.01% xylazine, 0.001% butorphanol, and 0.2% propofol (XBP) at doses of 6 (G6; 10 μg/kg/min xylazine, 1 μg/kg/min butorphanol, 200 μg/kg/min propofol) and 9 mL/kg/h (G9; 15 μg/kg/min xylazine, 1.5 μg/kg/min butorphanol 300 μg/kg/min propofol). For both groups, five castrated Holstein calves received intravenous injections of xylazine (0.2 mg/kg) and propofol (2 mg/kg), followed by a continuous infusion of XBP for 60 min to maintain anesthesia. Respiratory management consisted of tracheal intubation followed by spontaneous inhalation of pure oxygen. Cardiopulmonary, anesthesia, hematology, and blood biochemistry variables were assessed at rest (baseline) and every 5 or 15 min after the start of the XBP infusion. Quality of arousal was assessed based on the swallowing reflex recovery time from the stop of XBP infusion, and the sternal position time and standing time after atipamezole administration. XBP produced adequate sedation, analgesia, and muscle relaxation in all calves and maintained stable anesthesia for 60 min. As XBP infusion time passed, rectal temperature and heart rate became lower, and mean arterial blood pressure increased. In both groups, hematologic and blood biochemical effects were mild. The quality of arousal was not different, and all calves were standing. The results of the present study suggested that XBP is useful for TIVA in calves.
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Affiliation(s)
- Shogo Sato
- School of Veterinary Medicine, Kitasato University, 35-1, Higashi-23Bancho, Towadashi, Aomori, 034-8628, Japan
| | - Yuri Yamano
- School of Veterinary Medicine, Kitasato University, 35-1, Higashi-23Bancho, Towadashi, Aomori, 034-8628, Japan
| | - Chihiro Kanno
- School of Veterinary Medicine, Kitasato University, 35-1, Higashi-23Bancho, Towadashi, Aomori, 034-8628, Japan
| | - Yosuke Maeda
- School of Veterinary Medicine, Kitasato University, 35-1, Higashi-23Bancho, Towadashi, Aomori, 034-8628, Japan
| | - Fumiaki Takahashi
- School of Veterinary Medicine, Kitasato University, 35-1, Higashi-23Bancho, Towadashi, Aomori, 034-8628, Japan.
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Kimura S, Sone M, Sugawara S, Itou C, Ozawa M, Sato T, Matsui Y, Arai Y, Kusumoto M. Safety of propofol sedation administered by interventional radiologists for radiofrequency ablation in patients with hepatocellular carcinoma. Jpn J Radiol 2024:10.1007/s11604-024-01615-2. [PMID: 38922567 DOI: 10.1007/s11604-024-01615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To evaluate the safety of propofol sedation administered by interventional radiologists during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Propofol sedation was administered by interventional radiologists in 72 patients (85 procedures, 93 tumors) during RFA for HCC between August 2018 and December 2020. Interventional radiologists equipped with adequate knowledge and skills in sedation and respiratory management were responsible for sedation. Sedation was carefully assessed based on vital signs, including end-tidal carbon dioxide, consciousness status, and bispectral index. The primary endpoint was the incidence of sedation-related complications, which were evaluated separately as respiratory and cardiovascular complications. Secondary endpoints were technical success rate, ablation-related complications, and local tumor control rate. Technical success was defined as completion of ablation in the planned area. Complications were evaluated using the Clavien-Dindo classification. Sedation-related complications, technical success rate, and ablation-related complications were evaluated on a procedure basis, and local tumor control was evaluated on a tumor basis. RESULTS Respiratory and cardiovascular complications were observed in eight (8/85, 9.4%) and two (2/85, 2.4%) patients, respectively. Four patients required the jaw thrust maneuver due to glossoptosis, whereas a decrease in oxygen saturation to < 90% was recorded in the other four patients. However, these were temporary, and none required manual ventilation or endotracheal intubation. Bradycardia (< 50 bpm) was detected in two patients; one recovered immediately without treatment, whereas the other rapidly improved after atropine sulfate administration. No severe hypotension (< 80 mmHg) was observed. The technical success rate was 100% (85/85). Grade 3 ablation-related complications were identified in three patients (3/85, 3.5%). The local tumor control rate was 95.7% (89/93). CONCLUSION Propofol sedation can be safely administered by interventional radiologists during RFA for HCC. Although it requires special safety considerations, it may be a sedation option during hepatic RFA.
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Affiliation(s)
- Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan.
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mizuki Ozawa
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Tetsufumi Sato
- Department of Anesthesia and Intensive Care, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshiyuki Matsui
- Cancer Medicine, The Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Masahiko Kusumoto
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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5
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Huang Z, Bai Y, Chen Y, Chen Y, Jiang Y, Zhou J. Attenuation of intestinal ischemia-reperfusion-injury by anesthetics: a potentially protective effect of anesthetic management in experimental studies. Front Pharmacol 2024; 15:1367170. [PMID: 38444936 PMCID: PMC10912591 DOI: 10.3389/fphar.2024.1367170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 03/07/2024] Open
Abstract
Intestinal ischemia-reperfusion injury (IRI) is a potentially severe clinical syndrome after major surgical procedures. In addition to causing intestinal mucosa injury, intestinal IRI further damages distant organs, causing the severity of the condition in patients. So far, effective therapy for intestinal IRI is still absent, and the survival rate of the patients is low. Previous experimental studies have shown that some anesthetics can alleviate intestinal IRI and protect organs while exerting their pharmacological effects, indicating that reasonable perioperative anesthesia management may provide potential benefits for patients to avoid intestinal IRI. These meaningful findings drive scholars to investigate the mechanism of anesthetics in treating intestinal IRI in-depth to discuss the possible new clinical uses. In the present mini-review, we will introduce the protective effects of different anesthetics in intestinal IRI to help us enrich our knowledge in this area.
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Affiliation(s)
- Zhan Huang
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
- Department of Anesthesiology, Dazhou Integrated TCM & Western Medicine Hospital, Dazhou Second People’s Hospital, Dazhou, China
| | - Yiping Bai
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Ying Chen
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
| | - Ye Chen
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
- Department of Traditional Chinese Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, China
| | - Yuan Jiang
- Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jun Zhou
- Department of Anesthesiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Anesthesiology and Critical Care Medicine Key Laboratory of Luzhou, Southwest Medical University, Luzhou, China
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Håkansson I, Ahlander BM, Höök A, Kihlberg J. Retrospective comparison between MRI examinations during radiographer-administered intranasal sedation or general anesthesia. Radiography (Lond) 2024; 30:296-300. [PMID: 38071937 DOI: 10.1016/j.radi.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION In order for young children to be able to undergo a Magnetic Resonance Imaging (MRI) examination, general anesthesia is often required. The aim of this study was to compare the image quality, times, and costs of the examinations of infant brains performed with MRI either during sedation with dexmedetomidine administered by radiographers or anesthesia with propofol administered by anesthesia staff. METHODS This study was a quantitative retrospective study of 27 consecutive standard brain examinations performed under sedation or anesthesia, involving 15 children under sedation and 12 under anesthesia. The age of the children was from 0.5 to five years old. The image quality was evaluated by three radiologists experienced in pediatric MRI examinations. Information such as examination time and the expense of the examination was also collected. RESULTS There was no statistically significant difference in the general image quality, but one image series was assessed to have significantly better image quality under sedation than under anesthesia, but all images had very high quality. However, it emerged that children under anesthesia were at the hospital on average 55 min longer and the scanner room was occupied 20 min longer on average. The anesthesia examinations were three times more expensive. CONCLUSION This study demonstrated equivalent image quality between sedation and anesthesia. In addition, sedation was less time-consuming and had a lower price, partly because no extra anesthetic staff were required. The use of intranasal sedation offers a possibility to expand the competence area for radiographers. IMPLICATIONS FOR PRACTICE If radiographers learn to perform intranasal sedation, examinations can be performed in less time, at a third of the staff costs while maintaining image quality.
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Affiliation(s)
- I Håkansson
- Ryhov County Hospital, Department of Radiology, Jönköping, Sweden
| | - B-M Ahlander
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Gjuterigatan 5, SE-553 18, Jönköping, Sweden
| | - A Höök
- Department of Anaesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - J Kihlberg
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
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Gruzmark F, Shaikh N, Rainey SC, Hanson KA. Safety of Non-Operating Room Anesthesia With Propofol Sedation in Three Pediatric Patients With Central Sleep Apnea. J Pediatr Pharmacol Ther 2023; 28:568-572. [PMID: 38130343 PMCID: PMC10731944 DOI: 10.5863/1551-6776-28.6.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 12/23/2023]
Abstract
Children with central sleep apnea may require sedation for procedures, including brain imaging as part of the evaluation of apnea. However, the safety of deep sedation without a protected airway is not known in this patient population. In this case series, we present 3 children with central sleep apnea who were sedated with propofol for brain imaging in a non-operating room setting. All 3 did well with no complications; those with a home oxygen requirement were on oxygen during the procedure but none experienced apnea, desaturation, or respiratory distress. While obstructive sleep apnea is a known contraindication to deep sedation with propofol, it may be safe in pediatric patients with central sleep apnea. Deep sedation may be a good option for these patients, thereby avoiding the need for general anesthesia and placement of an advanced airway.
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Affiliation(s)
- Fiona Gruzmark
- Department of Pediatrics (FG, NS, KH), University of Illinois College of Medicine at Peoria, and OSF Healthcare Children's Hospital of Illinois, Peoria, IL
| | - Nadia Shaikh
- Department of Pediatrics (FG, NS, KH), University of Illinois College of Medicine at Peoria, and OSF Healthcare Children's Hospital of Illinois, Peoria, IL
| | - Shane C Rainey
- University of Arizona College of Medicine-Phoenix (SR), Phoenix, AZ
| | - Keith A Hanson
- Department of Pediatrics (FG, NS, KH), University of Illinois College of Medicine at Peoria, and OSF Healthcare Children's Hospital of Illinois, Peoria, IL
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Zeng B, Liu Y, Xu J, Niu L, Wu Y, Zhang D, Tang X, Zhu Z, Chen Y, Hu L, Yu S, Yu P, Zhang J, Wang W. Future Directions in Optimizing Anesthesia to Reduce Perioperative Acute Kidney Injury. Am J Nephrol 2023; 54:434-450. [PMID: 37742618 DOI: 10.1159/000533534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Perioperative acute kidney injury (AKI) is common in surgical patients and is associated with high morbidity and mortality. There are currently few options for AKI prevention and treatment. Due to its complex pathophysiology, there is no efficient medication therapy to stop the onset of the injury or repair the damage already done. Certain anesthetics, however, have been demonstrated to affect the risk of perioperative AKI in some studies. The impact of anesthetics on renal function is particularly important as it is closely related to the prognosis of patients. Some anesthetics can induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. Propofol, sevoflurane, and dexmedetomidine are a few examples of anesthetics that have protective association with AKI in the perioperative period. SUMMARY In this study, we reviewed the clinical characteristics, risk factors, and pathogenesis of AKI. Subsequently, the protective effects of various anesthetic agents against perioperative AKI and the latest research are introduced. KEY MESSAGE This work demonstrates that a thorough understanding of the reciprocal effects of anesthetic drugs and AKI is crucial for safe perioperative care and prognosis of patients. However, more complete mechanisms and pathophysiological processes still need to be further studied.
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Affiliation(s)
- Bin Zeng
- Department of Gastroenterology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yinuo Liu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China,
- The Second Clinical Medical College of Nanchang University, Nanchang, China,
| | - Jiawei Xu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Liyan Niu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
- Huan Kui College, Nanchang University, Nanchang, China
| | - Yuting Wu
- Huan Kui College, Nanchang University, Nanchang, China
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Deju Zhang
- Huan Kui College, Nanchang University, Nanchang, China
- Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Hong Kong, Hong Kong, China
| | - Xiaoyi Tang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zicheng Zhu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yixuan Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Leilei Hu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuchun Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Peng Yu
- Department of Metabolism and Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wenting Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
- Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yu Y, Li Y, Han D, Gong C, Wang L, Li B, Yao R, Zhu Y. Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2318611. [PMID: 37326991 PMCID: PMC10276303 DOI: 10.1001/jamanetworkopen.2023.18611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/01/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) is common in people who have experienced trauma, especially those hospitalized for surgery. Dexmedetomidine may reduce or reverse the early consolidation and formation of conditioned fear memory and prevent the occurrence of postoperative PTSD. Objective To evaluate the effects of intraoperative and postoperative low-dose intravenous pumping dexmedetomidine on PTSD among patients with trauma undergoing emergency surgery. Design, Setting, and Participants This double-blind, randomized clinical trial was conducted from January 22 to October 20, 2022, with follow-up 1 month postoperatively, in patients with trauma undergoing emergency surgery at 4 hospital centers in Jiangsu Province, China. A total of 477 participants were screened. The observers were blinded to patient groupings, particularly for subjective measurements. Interventions Dexmedetomidine or placebo (normal saline) was administered at a maintenance dose of 0.1 μg/kg hourly from the start of anesthesia until the end of surgery and at the same rate after surgery from 9 pm to 7 am on days 1 to 3. Main Outcomes and Measures The primary outcome was the difference in the incidence of PTSD 1 month after surgery in the 2 groups. This outcome was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (CAPS-5). The secondary outcomes were the pain score within 48 hours and 1 month postoperatively; incidence of postoperative delirium, nausea, and pruritus; subjective sleep quality; anxiety; and occurrence of adverse events. Results A total of 310 patients (154 in the normal saline group and 156 in the dexmedetomidine group) were included in the modified intention-to-treat analysis (mean [SD] age, 40.2 [10.3] years; 179 men [57.7%]). The incidence of PTSD was significantly lower in the dexmedetomidine group than in the control group 1 month postoperatively (14.1% vs 24.0%; P = .03). The participants in the dexmedetomidine group had a significantly lower CAPS-5 score than those in the control group (17.3 [5.3] vs 18.9 [6.6]; mean difference, 1.65; 95% CI, 0.31-2.99; P = .02). After adjusting for potential confounders, the patients in the dexmedetomidine group were less likely to develop PTSD than those in the control group 1 month postoperatively (adjusted odds ratio, 0.51; 95% CI, 0.27-0.94; P = .03). Conclusions and Relevance In this randomized clinical trial, the administration of intraoperative and postoperative dexmedetomidine reduced the incidence of PTSD among patients with trauma. The findings of this trial support the use of dexmedetomidine in emergency trauma surgery. Trial Registration Chinese Clinical Trial Register Identifier: ChiCTR2200056162.
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Affiliation(s)
- Youjia Yu
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
| | - Yan Li
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
| | - Dan Han
- Department of Anesthesiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Chuhao Gong
- Department of Anesthesiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Liwei Wang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Beiping Li
- Department of Anesthesiology, Xuzhou First People’s Hospital, Xuzhou, China
| | - Rui Yao
- Department of Anesthesiology, Xuzhou First People’s Hospital, Xuzhou, China
| | - Yangzi Zhu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
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Luo W, Sun M, Wan J, Zhang Z, Huang J, Zhang J, Xiong W, Xia L, Xu P, Miao C, Zhang X, Liu M, Zhong J. Efficacy and safety of remimazolam tosilate versus propofol in patients undergoing day surgery: a prospective randomized controlled trial. BMC Anesthesiol 2023; 23:182. [PMID: 37237331 DOI: 10.1186/s12871-023-02092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Remimazolam tosilate (RT) is a novel short-acting GABA (A) receptor agonist that has a rapid recovery from procedural sedation and can be fully reversed by flumazenil. To date, there have been relatively few articles comparing RT and propofol for general anesthesia. This study aimed to assess the efficacy and safety of RT with or without flumazenil compared with propofol in general anesthesia for day surgery. METHODS 115 patients scheduled for day surgery were randomized into three groups: RT (n = 39), RT + flumazenil (n = 38) and propofol (n = 38). The primary endpoints were anesthesia induction time and time until fully alert. Anesthesia success rate, bispectral index (BIS) values, injection pain, opioid and vasopressor dosages, postoperative recovery profiles and perioperative inflammatory and cognitive changes were assessed. Any adverse events were recorded. RESULTS Induction times were similar among the three groups (P = 0.437), but the median time until fully alert in patients treated with RT was longer than that of the propofol or RT + flumazenil groups (17.6 min vs. 12.3 min vs. 12.3 min, P < 0.001). The three groups had comparable postoperative recovery quality and inflammatory and cognitive state changes (P > 0.05). Smaller percentages of patients who received RT (26.3%) and RT + flumazenil (31.6%) developed hypotension during anesthesia maintenance compared with propofol (68.4%), and consequently less ephedrine (P < 0.001) and phenylephrine (P = 0.015) were needed in the RT group. Furthermore, serum triglyceride levels were lower (P < 0.001) and injection pain was much less frequent in the RT with or without flumazenil groups compared with the propofol group (5.3% vs. 0% vs. 18.4%). CONCLUSION RT permits rapid induction and comparable recovery profile compared with propofol in general anesthesia for day surgery, but has a prolonged recovery time without flumazenil. The safety profile of RT was superior to propofol in terms of hypotension and injection pain. TRIAL REGISTRATION The study was registered at Chinese Clinical Trial Registry http://www.chictr.org.cn/ (Registration date: 19/7/2021; Trial ID: ChiCTR2100048904).
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Affiliation(s)
- Wenchen Luo
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Minli Sun
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Jie Wan
- School of Anesthesiology, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Zhenyu Zhang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Jian Huang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Jinlin Zhang
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Wanxia Xiong
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Lirong Xia
- Jiangsu Jiangyin People's Hospital, Jiangyin, Jiangsu, People's Republic of China
| | - Peiyao Xu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Perioperative Stress and Protection, Shanghai, People's Republic of China
| | - Xuesong Zhang
- Department of Anesthesiology, Zhongshan Wusong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Mingyue Liu
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China.
| | - Jing Zhong
- Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032, People's Republic of China.
- Fudan Zhangjiang Institute, Shanghai, People's Republic of China.
- Department of Anesthesiology, Zhongshan Wusong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China.
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Ahmed M, Krishna Y, Popova P, Herbert R, Sidaras G, Choudhary A, Kaye SB. Low-Dose Propofol with Peribulbar Anaesthesia for Cataract Surgery. J Clin Med 2023; 12:jcm12072742. [PMID: 37048825 PMCID: PMC10095169 DOI: 10.3390/jcm12072742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP.
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Affiliation(s)
- Mahmoud Ahmed
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Yamini Krishna
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Petya Popova
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Rose Herbert
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Gediminas Sidaras
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Anshoo Choudhary
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Stephen B Kaye
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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12
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The Development and Optimization of Lipid-Based Self-Nanoemulsifying Drug Delivery Systems for the Intravenous Delivery of Propofol. Molecules 2023; 28:molecules28031492. [PMID: 36771156 PMCID: PMC9920530 DOI: 10.3390/molecules28031492] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Propofol is a relatively short-acting potent anesthetic lipophilic drug used during short surgical procedures. Despite the success of propofol intravenous emulsions, drawbacks to such formulations include inherent emulsion instability, the lack of a safe vehicle to prevent sepsis, and concern regarding hyperlipidemia-related side effects. The aim of the current investigation was to develop a novel, lipid-based self-nanoemulsifying drug delivery system (SNEDDS) for propofol with improved stability and anesthetic activity for human use. METHODS A series of SNEDDS formulations were developed using naturally obtained medium-chain/long-chain mono-, di-, and triglycerides, glyceryl monocaprylate, and water-soluble cosolvents with hydrogenated castor oil constructing ternary phase diagrams for propofol. The developed SNEDDS formulations were characterized using visual observation, particle size analysis, zeta potential, transmission electron microscopy, equilibrium solubility, in vitro dynamic dispersion and stability, and in vivo sleeping disorder studies in rats. The in vivo bioavailability of the SNEDDSs in rats was also studied to compare the representative formulations with the marketed product Diprivan®. RESULTS Medium-chain triglycerides (M810) with mono-diglycerides (CMCM) as an oil blend and hydrogenated castor oil (KHS15) as a surfactant were selected as key ingredients in ternary phase diagram studies. The nanoemulsifying regions were identified from the studies and a number of SNEDDSs were formulated. Results from the characterization studies demonstrated the formation of efficient nanosized particles (28-45 nm globule size, 0.10-0.20 PDI) in the optimized SNEDDS with a drug loading of 50 mg/g, which is almost 500-fold higher than free propofol. TEM analysis showed the formation of spherical and homogeneous nanoparticles of less than 50 nm. The dissolution rate of the representative SNEDDS was faster than raw propofol and able to maintain 99% propofol in aqueous solution for around 24 h. The optimized liquid SNEDDS formulation was found to be thermodynamically stable. The intravenous administration of the SNEDDS in male Wistar rats induced a sleeping time of 73-88 min. The mean plasma concentrations after the IV administration of propofol nano-formulations PF2-SNEDDS and PF8-SNEDDS were 1348.07 ± 27.31 and 1138.66 ± 44.97 µg/mL, as compared to 891.44 ± 26.05 µg/mL (p = 0.05) observed after the IV administration of raw propofol. CONCLUSION Propofol-loaded SNEDDS formulations could be a potential pharmaceutical product with improved stability, bioavailability, and anesthetic activity.
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Jeon S, Baik J, Kim J, Lee J, Do W, Kim E, Lee HJ, Kim H. Intrathecal dexmedetomidine attenuates mechanical allodynia through the downregulation of brain-derived neurotrophic factor in a mild traumatic brain injury rat model. Korean J Anesthesiol 2023; 76:56-66. [PMID: 35760392 PMCID: PMC9902181 DOI: 10.4097/kja.22209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study evaluated the effects of dexmedetomidine and propofol on brain-derived neurotrophic factor level in the cerebrospinal fluid (c-BDNF) and mechanical allodynia in a mild traumatic brain injury (TBI) rat model. METHODS After fixing the rat's skull on a stereotactic frame under general anesthesia, craniotomy was performed. After impact, 10 µl of drug was injected into the cisterna magna (group S: sham, group D: dexmedetomidine 5 μg/kg, group P: propofol 500 μg/kg, and group T: untreated TBI). The 50% mechanical withdrawal threshold (50% MWT) and c-BDNF level were measured on postoperative days (PODs) 1, 7, and 14. RESULTS The 50% MWT measured on PODs 1, 7, and 14 was lower and the c-BDNF level on POD 1 was higher in group T than in group S. In group D, the c-BDNF level on POD 1 was lower than that in group T and was comparable with that in group S during the whole study period. The 50% MWT of group D was higher than that of group T throughout the postoperative period. In group P, there were no significant differences in the 50% MWT during the entire postoperative period compared with group T; the c-BDNF level was higher than that in group T on POD 1. CONCLUSIONS Intrathecal administration of dexmedetomidine may attenuate TBI-induced mechanical allodynia for up to two weeks post-injury through immediate suppression of c-BDNF in mild TBI rats. The inhibition of c-BDNF expression in the acute phase reduced the occurrence of TBI-induced chronic neuropathic pain.
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Affiliation(s)
- Soeun Jeon
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Institute for Translational Research in Dentistry, Kyungpook National University, Daegu, Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea,Corresponding author: Jiseok Baik, M.D., Ph.D., Department of Anesthesia and Pain Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, KoreaTel: +82-51-240-7399Fax: +82-51-242-7466
| | - Jisu Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jiyoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
| | - Hyeon Jeong Lee
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
| | - Haekyu Kim
- Department of Anesthesia and Pain Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea,Pusan National University School of Medicine, Busan, Korea
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Guo F, Sun DF, Feng Y, Yang L, Li JL, Sun ZL. Efficacy and safety of propofol target-controlled infusion combined with butorphanol for sedated colonoscopy. World J Clin Cases 2023; 11:610-620. [PMID: 36793626 PMCID: PMC9923854 DOI: 10.12998/wjcc.v11.i3.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Propofol is a short-acting, rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection, diagnosis and treatment of colon diseases. However, the use of propofol alone may require high doses to achieve the induction of anesthesia in sedated colonoscopy, which has been associated with anesthesia-related adverse events (AEs), including hypoxemia, sinus bradycardia, and hypotension. Therefore, propofol co-administrated with other anesthetics has been proposed to reduce the required dose of propofol, enhance the efficacy, and improve the satisfaction of patients receiving colonoscopy under sedation.
AIM To evaluate the efficacy and safety of propofol target-controlled infusion (TCI) in combination with butorphanol for sedation during colonoscopy.
METHODS In this controlled clinical trial, a total of 106 patients, who were scheduled for sedated colonoscopy, were prospectively recruited and assigned into three groups to receive different doses of butorphanol before propofol TCI: Low-dose butorphanol group (5 μg/kg, group B1), high-dose butorphanol group (10 μg/kg, group B2), and control group (normal saline, group C). Anesthesia was achieved by propofol TCI. The primary outcome was the median effective concentration (EC50) of propofol TCI, which was measured using the up-and-down sequential method. The secondary outcomes included AEs in perianesthesia and recovery characteristics.
RESULTS The EC50 of propofol for TCI was 3.03 μg/mL [95% confidence interval (CI): 2.83-3.23 μg/mL] in group B2, 3.41 μg/mL (95%CI: 3.20-3.62 μg/mL) in group B1, and 4.05 μg/mL (95%CI: 3.78-4.34 μg/mL) in group C. The amount of propofol necessary for anesthesia was 132 mg [interquartile range (IQR), 125-144.75 mg] in group B2 and 142 mg (IQR, 135-154 mg) in group B1. Furthermore, the awakening concentration was 1.1 μg/mL (IQR, 0.9-1.2 μg/mL) in group B2 and 1.2 μg/mL (IQR, 1.025-1.5 μg/mL) in group B1. Notably, the propofol TCI plus butorphanol groups (groups B1 and B2) had a lower incidence of anesthesia AEs, when compared to group C. Furthermore, no significant differences were observed in the rates of AEs in perianesthesia, including hypoxemia, sinus bradycardia, hypotension, nausea and vomiting, and vertigo, among group C, group B1 and group B2.
CONCLUSION The combined use with butorphanol reduces the EC50 of propofol TCI for anesthesia. The decrease in propofol might contribute to the reduced anesthesia-related AEs in patients undergoing sedated colonoscopy.
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Affiliation(s)
- Feng Guo
- Department of Anesthesiology, No. 967 Hospital, Joint Logistics Support Force of Chinese People’s Liberation Army, Dalian 116011, Liaoning Province, China
| | - De-Feng Sun
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Yan Feng
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Lin Yang
- Department of Neuroelectrophysiology, The First Affiliated Hospital of Dalian Medical University, Dalian 11601, Liaoning Province, China
| | - Jing-Lin Li
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Zhong-Liang Sun
- Department of Anesthesiology, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Mao Y, Guo J, Yuan J, Zhao E, Yang J. Quality of Recovery After General Anesthesia with Remimazolam in Patients' Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol. Drug Des Devel Ther 2022; 16:1199-1209. [PMID: 35509490 PMCID: PMC9058002 DOI: 10.2147/dddt.s359496] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/14/2022] [Indexed: 12/25/2022] Open
Abstract
Background Remimazolam is a new medication with sedative and hypnotic effects. It has been demonstrated non-inferior to propofol in general anesthesia with regard to efficacy and safety. However, whether general anesthesia with remimazolam is better than propofol in terms of patients' recovery quality remains unknown. Patients and Methods Patients enrolled in this study were randomized to remimazolam or propofol group. In remimazolam group, general anesthesia was induced with remimazolam and sufentanil and maintained with remimazolam and remifentanil. In propofol group, general anesthesia was induced with propofol and sufentanil and maintained with propofol and remifentanil. Neuromuscular blocking agent cisatracurium was also injected during anesthesia. Sedation level was monitored by bispectral index (BIS). Our primary outcome was the quality of patients' postoperative recovery, using the Quality of Recovery-15 (QoR-15) scale. Secondary outcomes included SpO2, HR, MBP and frequency of application of vasoactive drugs during anesthesia, as well as incidences of adverse events in the post anesthesia care unit (PACU). Results The global scores of QoR-15 scale were lower in remimazolam group at postoperative day 1 and day 3 compared to propofol group, but differences between the two groups only had clinical significance at postoperative day 1. Among the five dimensions of QoR-15 scale, scores for physical comfort and emotional state were lower in remimazolam group than propofol group. MBP and HR were higher in remimazolam group than propofol group after anesthesia induction. SpO2 was similar in the two groups. The frequency of application of vasoactive drugs during anesthesia was higher in propofol group than remimazolam group. There was no statistical difference in the incidences of adverse events between the two groups. Conclusion General anesthesia with remimazolam can provide more stable hemodynamics but also cause temporary reduction in the quality of recovery in patients undergoing urologic surgery, compared to propofol.
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Affiliation(s)
- Yuanyuan Mao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jin Guo
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jingjing Yuan
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Erxian Zhao
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
| | - Jianjun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China
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Oda R, Shou J, Zhong W, Ozeki Y, Yasui M, Nuriya M. Direct visualization of general anesthetic propofol on neurons by stimulated Raman scattering microscopy. iScience 2022; 25:103936. [PMID: 35252821 PMCID: PMC8894261 DOI: 10.1016/j.isci.2022.103936] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
The consensus for the precise mechanism of action of general anesthetics is through allosteric interactions with GABA receptors in neurons. However, it has been speculated that these anesthetics may also interact with the plasma membrane on some level. Owing to the small size of anesthetics, direct visualization of these interactions is difficult to achieve. We demonstrate the ability to directly visualize a deuterated analog of propofol in living cells using stimulated Raman scattering (SRS) microscopy. Our findings support the theory that propofol is highly concentrated and interacts primarily through non-specific binding to the plasma membrane of neurons. Additionally, we show that SRS microscopy can be used to monitor the dynamics of propofol binding using real-time, live-cell imaging. The strategy used to visualize propofol can be applied to other small molecule drugs that have been previously invisible to traditional imaging techniques Multi-modal SRS developed for real-time biological imaging of small molecule substances Propofol primarily concentrates at the cell membrane of neurons Anesthesia dynamics can be monitored in real-time with SRS
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Affiliation(s)
- Robert Oda
- Department of Pharmacology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, 7-3-1 Hongo, Bunkyo, Tokyo 113-8656, Japan
- Corresponding author
| | - Jingwen Shou
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, 7-3-1 Hongo, Bunkyo, Tokyo 113-8656, Japan
| | - Wenying Zhong
- Department of Pharmacology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuyuki Ozeki
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, 7-3-1 Hongo, Bunkyo, Tokyo 113-8656, Japan
| | - Masato Yasui
- Department of Pharmacology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Mutsuo Nuriya
- Department of Pharmacology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
- Graduate School of Environment and Information Sciences, Yokohama National University, 79-1 Tokiwadai, Hodogaya, Yokohama, Kanagawa 240-8501, Japan
- Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency (JST), 4-1-8 Honcho, Kawaguchi, Saitama 332-0012, Japan
- Corresponding author
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Gao L, Zhang X. Propofol enhances the lethality of cisplatin on liver cancer cells by up-regulating miR-195-5p. Tissue Cell 2021; 74:101680. [PMID: 34808429 DOI: 10.1016/j.tice.2021.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Literatures have demonstrated that propofol can improve the efficacy of cisplatin, and miR-195 is implicated in the underlying mechanism concerning the anticancer effects of propofol. However, correlation between propofol and miR-195 has been little studied. This study clarified that propofol enhanced the inhibitory effect of cisplatin in liver cancer cells via miR-195-5p. 50 samples of liver cancer and para-cancer tissues in patients were collected and the difference in the expression of miR-195-5p was then analyzed. The liver cancer cells treated with gradient concentrations of cisplatin (3, 6.25, 12.5, 25, 50 μg/mL) and propofol (2, 5, 10 μg/mL) were tested for drug toxicity using CCK-8 assay. Next, following the transfection, the effects of propofol, cisplatin and miR-195-5p on the functions of liver cancer cells and the expressions of related proteins were analyzed by clone formation, flow cytometry and western blot. The downstream target genes of miR-195-5p were predicted by bio-informatics analysis and verified by dual-luciferase reporter assay, and their expressions in cancer cell was also calculated. The changes on the expressions of target genes were further detected by qRT-PCR and western blot. MiR-195-5p was lowly-expressed in liver cancer, and the up-regulation of miR-195-5p enhanced the sensitivity of liver cancer cells to cisplatin. Propofol inhibited the viability of liver cancer cells and stimulated the up-regulation of miR-195-5p. Propofol enhanced the lethality of cisplatin to liver cancer cells and reversed the repressive effects of miR-195-5p inhibitor on the efficacy of cisplatin. CCNE1 was the downstream target gene of miR-195-5p and its expression was up-regulated by miR-195-5p inhibitor in cisplatin-treated liver cancer cells. Collectively, propofol enhances the lethality of cisplatin to liver cancer cells by up-regulating miR-195-5p.
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Affiliation(s)
- Lan Gao
- Pharmacy Department, The People's Hospital of Xinchang, China
| | - Xiufeng Zhang
- Pharmacy Department, The People's Hospital of Xinchang, China.
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Kostroglou A, Kapetanakis EI, Rougeris L, Froudarakis ME, Sidiropoulou T. Review of the Physiology and Anesthetic Considerations for Pleuroscopy/Medical Thoracoscopy. Respiration 2021; 101:195-209. [PMID: 34518491 DOI: 10.1159/000518734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/22/2021] [Indexed: 11/19/2022] Open
Abstract
Pleuroscopy or medical thoracoscopy is the second most common utilized procedure after bronchoscopy in the promising field of interventional pulmonology. Its main application is for the diagnosis and management of benign or malignant pleural effusions. Entry into the hemithorax is associated with pain and patient discomfort, whereas concurrently, notable pathophysiologic alterations occur. Therefore, frequently procedural sedation and analgesia is needed, not only to alleviate the patient's emotional stress and discomfort by mitigating the anxiety and minimizing the pain but also for yielding better procedural conditions for the operator. The scope of this review is to present the physiologic derangements occurring in pleuroscopy and compare the various anesthetic techniques and sedative agents that are currently being used in this context.
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Affiliation(s)
- Andreas Kostroglou
- 2nd Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil I Kapetanakis
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Loizos Rougeris
- 2nd Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios E Froudarakis
- Department of Respiratory Medicine, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Tatiana Sidiropoulou
- 2nd Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Wang X, Meng J. Butorphanol versus Propofol in Patients Undergoing Noninvasive Ventilation: A Prospective Observational Study. Int J Gen Med 2021; 14:983-992. [PMID: 33790627 PMCID: PMC7997559 DOI: 10.2147/ijgm.s297356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background The present study aimed to explore sedation management in agitated patients who suffered from acute respiratory failure (ARF) and were treated with noninvasive ventilation (NIV). Patients and Methods We divided 118 patients undergoing NIV treatment with butorphanol or propofol into two groups: group B (n = 57, butorphanol was initiated at the rate of 0.12 µg/kg/min as a continuous intravenous infusion and then titrated by 0.06 µg/kg/min every half an hour, group P (n = 61, propofol was initiated at the rate of 5 µg/kg/min as a continuous intravenous infusion and then titrated by 1.5 µg/kg/min every half an hour). Score of Sedation Agitation Scale (SAS) in the two groups was maintained between 3 and 4. Medications including sedative, analgesic, and antipsychotic, NIV intolerance score, SAS score, visual analog scale (VAS), medication use and adverse events were recorded repeatedly. Results Patients receiving butorphanol required significantly less total amount of fentanyl than patients receiving propofol during NIV to maintain the target VAS [0 (0–0) µg vs 150 (50–200) µg, P< 0.005]. Hemodynamic stability during NIV showed it was better kept in patients treated with butorphanol. Conclusion Butorphanol not only decreased the requirements of fentanyl but also enhanced hemodynamic stability in agitated patients suffering from ARF receiving NIV. Trial Registration Registered at http://www.chictr.org.cn/ (ChiCTR1800015534).
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Affiliation(s)
- Xiaohong Wang
- Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, People's Republic of China
| | - Jianbiao Meng
- Intensive Care Unit, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang Province, 310012, People's Republic of China
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Fredheim OM, Skulberg IM, Magelssen M, Steine S. Clinical and ethical aspects of palliative sedation with propofol-A retrospective quantitative and qualitative study. Acta Anaesthesiol Scand 2020; 64:1319-1326. [PMID: 32632937 DOI: 10.1111/aas.13665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The anesthetic propofol is often mentioned as a drug that can be used in palliative sedation. The existing literature of how to use propofol in palliative sedation is scarce, with lack of information about how propofol could be initiated for palliative sedation, doses and treatment outcomes. AIM To describe the patient population, previous and concomitant medication, and clinical outcome when propofol was used for palliative sedation. METHODS A retrospective study with quantitative and qualitative data. All patients who during a 4.5-year period received propofol for palliative sedation at the Department of palliative medicine, Akershus University Hospital, Norway were included. RESULTS Fourteen patients were included. In six patients the main indication for palliative sedation was pain, in seven dyspnoea and in one delirium. In eight of these cases propofol was chosen because of the pharmacokinetic properties (rapid effect), and in the remaining cases propofol was chosen because midazolam in spite of dose titration failed to provide sufficient symptom relief. In all patients sedation and adequate symptom control was achieved during manual dose titration. During the maintenance phase three of 14 patients had spontaneous awakenings. At death, propofol doses ranged from 60 to 340 mg/hour. CONCLUSIONS Severe suffering at the end of life can be successfully treated with propofol for palliative sedation. This can be performed in palliative medicine wards, but skilled observation and dose titration throughout the period of palliative sedation is necessary. Successful initial sedation does not guarantee uninterrupted sedation until death. EDITORIAL COMMENT In palliative care, some patients at the end of life can reach a stage where there have been maximal analgesic and or anxiolytic treatments though without achieving comfort in the awake state. This report describes and discusses use of propofol in these infrequent cases to relieve suffering as part of palliative care.
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Affiliation(s)
- Olav M. Fredheim
- Department of Palliative Medicine Akershus University Hospital Lørenskog Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
- National Competence Centre for Complex Symptom Disorders Department of Pain and Complex Disorders St. Olavs Hospital Trondheim Norway
| | | | - Morten Magelssen
- Centre for Medical Ethics Institute of Health and Society University of Oslo Oslo Norway
| | - Siri Steine
- Department of Palliative Medicine Akershus University Hospital Lørenskog Norway
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Tortosa V, Pietropaolo V, Brandi V, Macari G, Pasquadibisceglie A, Polticelli F. Computational Methods for the Identification of Molecular Targets of Toxic Food Additives. Butylated Hydroxytoluene as a Case Study. Molecules 2020; 25:E2229. [PMID: 32397407 PMCID: PMC7248939 DOI: 10.3390/molecules25092229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 11/24/2022] Open
Abstract
Butylated hydroxytoluene (BHT) is one of the most commonly used synthetic antioxidants in food, cosmetic, pharmaceutical and petrochemical products. BHT is considered safe for human health; however, its widespread use together with the potential toxicological effects have increased consumers concern about the use of this synthetic food additive. In addition, the estimated daily intake of BHT has been demonstrated to exceed the recommended acceptable threshold. In the present work, using BHT as a case study, the usefulness of computational techniques, such as reverse screening and molecular docking, in identifying protein-ligand interactions of food additives at the bases of their toxicological effects has been probed. The computational methods here employed have been useful for the identification of several potential unknown targets of BHT, suggesting a possible explanation for its toxic effects. In silico analyses can be employed to identify new macromolecular targets of synthetic food additives and to explore their functional mechanisms or side effects. Noteworthy, this could be important for the cases in which there is an evident lack of experimental studies, as is the case for BHT.
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Affiliation(s)
- Valentina Tortosa
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
| | - Valentina Pietropaolo
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
| | - Valentina Brandi
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
| | - Gabriele Macari
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
| | - Andrea Pasquadibisceglie
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
| | - Fabio Polticelli
- Department of Sciences, Roma Tre University, 00146 Rome, Italy; (V.T.); (V.P.); (V.B.); (G.M.); (A.P.)
- National Institute of Nuclear Physics, Roma Tre University, 00146 Rome, Italy
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Song B, Li Y, Teng X, Li X, Yang Y, Zhu J. Comparison of Morning and Evening Operation Under General Anesthesia on Intraoperative Anesthetic Requirement, Postoperative Sleep Quality, and Pain: A Randomized Controlled Trial. Nat Sci Sleep 2020; 12:467-475. [PMID: 32765143 PMCID: PMC7371604 DOI: 10.2147/nss.s257896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Postoperative sleep disorders can cause serious adverse effects on postoperative outcomes. The purpose of our study was to compare the effects of the timing of surgery under general anesthesia on intraoperative anesthetic drug requirements, postoperative sleep quality and pain in patients. MATERIALS AND METHODS Eighty-four patients who underwent selective laparoscopic abdominal surgeries under general anesthesia were randomly assigned to the Day Group (8:00-12:00) or the Night Group (18:00-22:00). The portable sleep monitor (PSM) was used to determine sleep quality on the night before surgery (Sleep-preop), the first night after surgery (Sleep POD 1), and the third night after surgery (Sleep POD 3). The visual analog scale (VAS) was used to evaluate postoperative pain scores and the Athens Insomnia Scale (AIS) was used for assessing insomnia symptoms. The total dose of general anesthetics required and adverse effects after surgery were also assessed. RESULTS Compared to Sleep-preop, patients presented with a lower sleep efficiency and a higher AIS score during Sleep POD 1 and Sleep POD 3. Furthermore, the Night Group had a significantly lower proportion of rapid eye movement sleep, stable sleep, and unstable sleep than did the Day Group at Sleep POD 1 and Sleep POD 3. The dosage of propofol and remifentanil required in the Day Group was significantly higher than that in the Night Group. Furthermore, patients in the Day Group had better pain relief, with a lower VAS score at 1, 6, 12, and 24 hours after surgery. The incidences of postoperative nausea and vomiting and dizziness were significantly higher in the Night Group than those in the Day Group. CONCLUSION Morning operations required a higher dose of anesthetic drugs than did evening operations, which may be related to the circadian rhythm. The degree of postoperative sleep disorders was greater when the operation was performed in the evening than in the morning, which was also associated with increased pain perception and increased incidence of postoperative adverse effects. Thus, our results suggest that patients with hyperalgesia and sleep disorders may benefit from operations performed in the morning.
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Affiliation(s)
- Bijia Song
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yang Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiufei Teng
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xiuyan Li
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yanchao Yang
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Junchao Zhu
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
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DeGroot WD, Tobias KM, Browning DC, Zhu X. Examination of laryngeal function of healthy dogs by using sedation protocols with dexmedetomidine. Vet Surg 2019; 49:124-130. [PMID: 31603562 DOI: 10.1111/vsu.13334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/28/2019] [Accepted: 08/08/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the ability to evaluate laryngeal function under sedation with dexmedetomidine alone or in combination with opioids. STUDY DESIGN Randomized, crossover, blinded study. ANIMALS Eight adult research hounds weighing 8 to 22.5 kg. METHODS Dogs were sedated with propofol, dexmedetomidine, dexmedetomidine and butorphanol, or dexmedetomidine and hydromorphone. Digital images were collected with video laryngoscopy before and after doxapram administration. Maximal inspiratory normalized glottal gap (GGAn ) and laryngeal motion were compared between and within protocols before and after doxapram by using a difference of least squares mean. RESULTS Normal laryngeal function was confirmed in all dogs with all protocols except propofol, which resulted in two false positive results. No difference between protocols was detected for predoxapram GGAn . Postdoxapram GGAn was greater than predoxapram GGAn for all four sedation protocols (P ≤ .0030). Compared with propofol, postdoxapram GGAn was greater for all three dexmedetomidine protocols (P ≤ .0420). CONCLUSION Dexmedetomidine alone or in combination with opioids was an effective sedation protocol for laryngeal examination, producing sufficient immobilization to prevent jaw motion and without affecting arytenoid abduction. CLINICAL SIGNIFICANCE Dexmedetomidine sedation does not inhibit normal laryngeal motion. Laryngeal examination with propofol alone can produce false positive results.
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Affiliation(s)
- Whitney D DeGroot
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee
| | - Karen M Tobias
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee
| | - Danielle C Browning
- Department of Small Animal Clinical Sciences, University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee
| | - Xiaojuan Zhu
- Office of Information and Technology, University of Tennessee, Knoxville, Tennessee
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Franco F, Bolletta E, Mancioppi S, Franco E, Migliorelli A, Perri P. Topical Anesthesia in Children With Intraoperative Adjustable Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2019; 56:173-177. [PMID: 31116865 DOI: 10.3928/01913913-20190208-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate strabismus surgery with intraoperative adjustment of sutures under topical anesthesia in children. METHODS Nineteen children with horizontal deviation underwent a one-stage surgical technique performed under topical anesthesia. Surgery consisted of unilateral or bilateral recession and/or resection of horizontal muscles or the medial or lateral rectus muscles, with intraoperative adjustment of sutures based on alternate prism cover test. Follow-up was done at 1 day and 1, 3, and 6 months postoperatively. RESULTS Mean age at surgery was 12.68 ± 2.50 years (range: 8 to 16 years). Mean preoperative angle of deviation was 24.21 ± 11.20 prism diopters (PD) (range: -50 to +30 PD) at distance. Mean postoperative angle of deviation at 6 months was 4.11 ± 2.87 PD (range: -10 to +10 PD) at distance. In esotropic patients, the average angle of deviation decreased from +23.80 ± 5.89 PD preoperatively to +4.80 ± 3.35 PD at 6 months, whereas in exotropic patients it decreased from -24.36 ± 12.76 to -3.86 ± 2.77 PD. Seventeen of 19 patients (89%) remained comfortable during surgery, whereas 2 needed an intravenous injection of propofol. The success rate, defined by a postoperative residual angle of deviation of ±8 PD or less, was 89% at 6 months. CONCLUSIONS Strabismus surgery with intraoperative suture adjustment under topical anesthesia in children is a tolerable procedure with encouraging outcomes, representing an alternative to general anesthesia in well-selected children. Clinical evaluation of children and parents is fundamental to predict a likely poor collaboration of the child during surgery, which, if present, would require surgery under general anesthesia. [J Pediatr Ophthalmol Strabismus. 2019;56(3):173-177.].
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Guntner AS, Stöcklegger S, Kneidinger M, Illievich U, Buchberger W. Development of a highly sensitive gas chromatography-mass spectrometry method preceded by solid-phase microextraction for the analysis of propofol in low-volume cerebral microdialysate samples. J Sep Sci 2019; 42:1257-1264. [PMID: 30637930 PMCID: PMC6590146 DOI: 10.1002/jssc.201801066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/17/2019] [Accepted: 01/09/2019] [Indexed: 12/11/2022]
Abstract
To date, the commonly used intravenous anesthetic propofol has been widely studied, and fundamental pharmacodynamic and pharmacokinetic characteristics of the drug are known. However, propofol has not yet been quantified in vivo in the target organ, the human brain. Here, cerebral microdialysis offers the unique opportunity to sample propofol in the living human organism. Therefore, a highly sensitive analytical method for propofol quantitation in small sample volumes of 30 μL, based on direct immersion solid‐phase microextraction was developed. Preconcentration was followed by gas chromatographic separation and mass spectrometric detection of the compound. This optimized method provided a linear range between the lower limit of detection (50 ng/L) and 200 μg/L. Matrix‐matched calibration was used to compensate recovery issues. A precision of 2.7% relative standard deviation between five consecutive measurements and an interday precision of 6.4% relative standard deviation could be achieved. Furthermore, the permeability of propofol through a cerebral microdialysate system was tested. In summary, the developed method to analyze cerebral microdialysate samples, allows the in vivo quantitation of propofol in the living human brain. Additionally the calculation of extracellular fluid levels is enabled since the recovery of the cerebral microdialysis regarding propofol was determined.
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Affiliation(s)
| | - Simon Stöcklegger
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Michael Kneidinger
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Udo Illievich
- Department for Neuroanesthesia and Intensive Care, Kepler University Hospital Neuromed Campus, Linz, Austria
| | - Wolfgang Buchberger
- Institute of Analytical Chemistry, Johannes Kepler University, Linz, Austria
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 30143318 PMCID: PMC9391781 DOI: 10.1016/j.bjane.2018.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background and objectives Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. Methods After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. Results 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081 s for every mg.kg−1 of propofol; CI95%: −7906 to −0.255, p = 0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. Conclusions Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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González Moral ML, Selva Sevilla C, Romero Rodenas P, Tolosa Pérez MT, Lucas Pérez-Romero M, Domato Lluch M, Gerónimo Pardo M. [Influence of propofol dose and blood components on duration of electrical seizures in electroconvulsive therapy]. Rev Bras Anestesiol 2018; 68:564-570. [PMID: 30143318 DOI: 10.1016/j.bjan.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/19/2018] [Accepted: 03/30/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight-adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight-adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect. METHODS After approval of the Institutional Review Board, a retrospective chart review was performed of all patients who underwent at least one electroconvulsive therapy session. Multiple lineal regression analysis adjusted for potential confounders was employed to explore the effect of propofol dosage on values of bispectral index and on duration of seizure; bivariate correlation analyses were previously performed to identify variables fulfilling confounding criteria, specifically values of Spearman's rho >0.10. Results of regression analysis were expressed as B coefficient with its 95% confident interval. RESULTS 76 patients received 631 acute phase sessions. Propofol showed a statistically significant negative effect on duration of seizure (specifically a reduction of 4.081s for every mg.kg-1 of propofol; CI95%: -7906 to -0.255, p=0.037) but not on bispectral index values. Slight anemia and hypoalbuminemia were very infrequent conditions, and the anticonvulsant effect was not influenced by these parameters. CONCLUSIONS Propofol weight-adjusted dose is negatively related to duration of seizures. It should be carefully titrated when employed to perform electroconvulsive therapy.
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Affiliation(s)
| | | | - Patricia Romero Rodenas
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | | | - Marta Lucas Pérez-Romero
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Mar Domato Lluch
- Complejo Hospitalario Universitario de Albacete, Departamento de Salud Mental, Albacete, Espanha
| | - Manuel Gerónimo Pardo
- Complejo Hospitalario Universitario de Albacete, Departamento de Anestesiología, Albacete, Espanha.
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Xiong M, Shiwalkar N, Reddy K, Shin P, Bekker A. Neurobiology of Propofol Addiction and Supportive Evidence: What Is the New Development? Brain Sci 2018; 8:brainsci8020036. [PMID: 29470436 PMCID: PMC5836055 DOI: 10.3390/brainsci8020036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/14/2018] [Accepted: 02/18/2018] [Indexed: 12/21/2022] Open
Abstract
Propofol is a short-acting intravenous anesthetic agent suitable for induction and maintenance of general anesthesia as well as for procedural and intensive care unit sedation. As such it has become an unparalleled anesthetic agent of choice in many institutional and office practices. However, in addition to its idealistic properties as an anesthetic agent, there is accumulating evidence suggesting its potential for abuse. Clinical and experimental evidence has revealed that not only does propofol have the potential to be abused, but also that addiction to propofol shows a high mortality rate. Based on this evidence, different researchers have shown interest in determining the probability of propofol to be an addictive agent by comparing it with other drugs of abuse and depicting a functional similitude that involves the mesocorticolimbic pathway of addiction. In light of this, the Drug Enforcement Agency and the American Society of Anesthesiologists have put forth certain safety recommendations for the use of propofol. Despite this, the abuse potential of propofol has been challenged at different levels and therefore the preeminent focus will be to further validate the linkage from medicinal and occasional use of propofol to its addiction, as well as to explore the cellular and molecular targets involved in establishing this linkage, so as to curb the harm arising out of it. This review incorporates the clinical and biomolecular evidence supporting the abuse potential of propofol and brings forth the promising targets and the foreseeable mechanism causing the propofol addiction phenotypes, which can be called upon for future developments in this field.
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Affiliation(s)
- Ming Xiong
- Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ 07107, USA.
| | - Nimisha Shiwalkar
- Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ 07107, USA.
| | - Kavya Reddy
- Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ 07107, USA.
| | - Peter Shin
- Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ 07107, USA.
| | - Alex Bekker
- Department of Anesthesiology, New Jersey Medical School, Rutgers University, Newark, NJ 07107, USA.
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Sartiani L, Mannaioni G, Masi A, Novella Romanelli M, Cerbai E. The Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels: from Biophysics to Pharmacology of a Unique Family of Ion Channels. Pharmacol Rev 2017; 69:354-395. [PMID: 28878030 DOI: 10.1124/pr.117.014035] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/07/2017] [Indexed: 12/22/2022] Open
Abstract
Hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels are important members of the voltage-gated pore loop channels family. They show unique features: they open at hyperpolarizing potential, carry a mixed Na/K current, and are regulated by cyclic nucleotides. Four different isoforms have been cloned (HCN1-4) that can assemble to form homo- or heterotetramers, characterized by different biophysical properties. These proteins are widely distributed throughout the body and involved in different physiologic processes, the most important being the generation of spontaneous electrical activity in the heart and the regulation of synaptic transmission in the brain. Their role in heart rate, neuronal pacemaking, dendritic integration, learning and memory, and visual and pain perceptions has been extensively studied; these channels have been found also in some peripheral tissues, where their functions still need to be fully elucidated. Genetic defects and altered expression of HCN channels are linked to several pathologies, which makes these proteins attractive targets for translational research; at the moment only one drug (ivabradine), which specifically blocks the hyperpolarization-activated current, is clinically available. This review discusses current knowledge about HCN channels, starting from their biophysical properties, origin, and developmental features, to (patho)physiologic role in different tissues and pharmacological modulation, ending with their present and future relevance as drug targets.
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Affiliation(s)
- Laura Sartiani
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Firenze, Italy
| | - Guido Mannaioni
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Firenze, Italy
| | - Alessio Masi
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Firenze, Italy
| | - Maria Novella Romanelli
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Firenze, Italy
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research, and Child Health, University of Florence, Firenze, Italy
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Covarrubias-Gómez A, López Collada-Estrada M. Propofol-Based Palliative Sedation to Treat Antipsychotic-Resistant Agitated Delirium. J Pain Palliat Care Pharmacother 2017; 31:190-194. [PMID: 28506099 DOI: 10.1080/15360288.2017.1315476] [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] [Indexed: 01/28/2023]
Abstract
Delirium is a common problem in terminally ill patients that is associated with significant distress and, hence, considered a palliative care emergency. The three subtypes of delirium are hyperactive, hypoactive, and mixed, depending on the level of psychomotor activity and arousal disturbance. When agitated delirium becomes refractory in the setting of imminent dying, the agitation may be so severe that palliative sedation (PS) is required. Palliative sedation involves the administration of sedative medications with the purpose of reducing level of consciousness for patients with refractory suffering in the setting of a terminal illness. Propofol is a sedative that has a short duration of action and a very rapid onset. These characteristics make it relatively easy to titrate. Reported doses range from 50 to 70 mg per hour. The authors present a case of antipsychotic-resistant agitated delirium treated with a propofol intravenous infusion.
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Novella Romanelli M, Sartiani L, Masi A, Mannaioni G, Manetti D, Mugelli A, Cerbai E. HCN Channels Modulators: The Need for Selectivity. Curr Top Med Chem 2016; 16:1764-91. [PMID: 26975509 PMCID: PMC5374843 DOI: 10.2174/1568026616999160315130832] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022]
Abstract
Hyperpolarization-activated, cyclic nucleotide-gated (HCN) channels, the molecular correlate of the hyperpolarization-activated current (If/Ih), are membrane proteins which play an important role in several physiological processes and various pathological conditions. In the Sino Atrial Node (SAN) HCN4 is the target of ivabradine, a bradycardic agent that is, at the moment, the only drug which specifically blocks If. Nevertheless, several other pharmacological agents have been shown to modulate HCN channels, a property that may contribute to their therapeutic activity and/or to their side effects. HCN channels are considered potential targets for developing drugs to treat several important pathologies, but a major issue in this field is the discovery of isoform-selective compounds, owing to the wide distribution of these proteins into the central and peripheral nervous systems, heart and other peripheral tissues. This survey is focused on the compounds that have been shown, or have been designed, to interact with HCN channels and on their binding sites, with the aim to summarize current knowledge and possibly to unveil useful information to design new potent and selective modulators.
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Affiliation(s)
- Maria Novella Romanelli
- University of Florence, Department of Neurosciences, Psychology, Drug Research and Child's Health, Section of Pharmaceutical and Nutraceutical Sciences, via Ugo Schiff 6, 50019 Sesto Fiorentino, Italy.
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Efeito da pré‐medicação com dose baixa de dexmedetomidina sobre o consumo de propofol em pacientes geriátricos com doença renal em estágio terminal. Braz J Anesthesiol 2015; 65:326-32. [DOI: 10.1016/j.bjan.2015.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/11/2014] [Indexed: 01/18/2023] Open
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Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients. Braz J Anesthesiol 2015; 65:326-32. [PMID: 26323728 DOI: 10.1016/j.bjane.2014.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/11/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sedation in dialysis dependent end-stage renal disease patients requires caution as a result of performing high doses of sedatives and its complications. Multidrug sedation regimens might be superior and advantage on lesser drug consumption and by the way adverse events which occur easily in end-stage renal disease patients. We evaluated the effects of dexmedetomidine premedication on propofol consumption, sedation levels with Observer's Assessment of Alertness and Sedation scores and the bispectral index and the hemodynamic changes, potential side effects in geriatric patients with end-stage renal disease who underwent hip fracture surgery under spinal anesthesia. METHOD In this randomized, controlled, double-blind study 60 elderly patients (age≥65 years) with end-stage renal disease and hip fracture scheduled for anterograde femoral intramedullary nailing were assigned to groups that received either intravenous saline infusion (Group C) or dexmedetomidine 0.5μg/kg/10min infusion for premedication (Group D). All the patients received propofol infusion after the induction of the spinal anesthesia. RESULTS Total propofol consumption, propofol dose required for targeted sedation levels according to Observer's Assessment of Alertness and Sedation scores and bispectral index levels, recovery times were significantly lower in Group D (p<0.001). The time to reach to Observer's Assessment of Alertness and Sedation score 4 and to achieve bispectral index≤80 was significantly lower in Group C compared with Group D (p<0.001). Adverse events were similar in both groups. CONCLUSION Dexmedetomidine premedication lowers intraoperative propofol consumption to maintain targeted level of sedation. Therefore low dose dexmedetomidine premedication in addition to propofol infusion might be an alternative in geriatric patients with end-stage renal disease for sedation.
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Naser AS, Mohammad FK. Central depressant effects and toxicity of propofol in chicks. Toxicol Rep 2014; 1:562-568. [PMID: 28962269 PMCID: PMC5598420 DOI: 10.1016/j.toxrep.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/05/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022] Open
Abstract
Propofol is an ultra-short acting anesthetic agent. The information on the pharmacological and toxicological effects of propofol in the chicken is rather limited. This study examines the toxicity and pharmaco-behavioral effects of propofol given intraperitoneally in 7–10 day-old chicks. The median effective doses of propofol for the induction of sedation, analgesia to electric stimulation and sleep in the chicks were 1.82, 2.21 and 5.71 mg/kg, respectively. The 24-h median lethal dose of propofol in chicks was 57.22 mg/kg. The therapeutic indices of propofol for sedation, analgesia and sleep were 31.4, 25.9 and 10, respectively. Propofol at 0.5 and 1 mg/kg reduced the locomotor activity and increased the duration of tonic immobility in chicks. Propofol at 2 and 4 mg/kg caused analgesia to electric stimulation as well as analgesia and anti-inflammatory responses against formalin test in chicks. Propofol at 5, 10 and 20 mg/kg induced sleep in chicks for 8.4 to 25 min. Physostigmine shortened the sleep duration of propofol. Data suggest that propofol induces anti-inflammatory action and central nervous system depression in chicks resulting in sedation, analgesia and anesthesia with wide safety margin. These effects could form the basis of further pharmacological and toxicological studies on propofol in the young chick model, and the drug could be safely applied clinically in the chicken.
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Affiliation(s)
- A S Naser
- Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine, University of Mosul, Mosul, Iraq
| | - F K Mohammad
- Department of Physiology, Biochemistry and Pharmacology, College of Veterinary Medicine, University of Mosul, Mosul, Iraq
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Hasan ZA, Abdel Razzak RL, Alzoubi KH. Comparison between the effect of propofol and midazolam on picrotoxin-induced convulsions in rat. Physiol Behav 2014; 128:114-8. [PMID: 24518860 DOI: 10.1016/j.physbeh.2014.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/26/2013] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Abstract
Propofol is a short acting intravenous anesthetic that has been used in the treatment of status epileptics. However, the occurrence of seizures in epileptic and non-epileptic patients during recovery from propofol induced anesthesia suggests that propofol may have proconvulsant effects. We have previously shown that propofol displays anticonvulsant effects against picrotoxin (PTX) induced seizures during its peak sedative effects. The purpose of the present study was to compare the time course of the effect of intravenous administration of various doses (2.5, 5, and 10 mg/kg) of propofol and midazolam on PTX-induced seizures in adult female Sprague-Dawley rats. The latency to onset of clonic seizures induced by intraperitoneal injection of PTX was significantly increased by the highest dose of propofol and all doses of midazolam, suggesting that both agents display anticonvulsant effects. The anticonvulsant effects of propofol (10 mg/kg) lasted about 20 min and PTX-induced clonic seizures were observed thereafter and peaked within 30 min post drug administration. Clonic seizures progressed rapidly to tonic seizures leading to high rate of PTX-induced mortality. In midazolam (10 mg/kg) treated rats, clonic seizures were observed 25 min after drug administration and the number of rats exhibiting clonic seizures was highest within 40 min. However, clonic seizures did not progress into tonic seizures and thus, PTX-induced seizure related mortality was significantly reduced. In conclusion, this study provides further evidence for the anticonvulsant effects of propofol and midazolam against PTX-induced seizures. Furthermore, the data of the current study showed that midazolam was more effective than propofol against PTX-induced tonic seizures.
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Affiliation(s)
- Zuheir A Hasan
- Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
| | - Rima L Abdel Razzak
- Department of Physiology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Delirium in adult patients receiving palliative care: A systematic review of the literature. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rpsmen.2013.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sánchez-Román S, Beltrán Zavala C, Lara Solares A, Chiquete E. Delirium in adult patients receiving palliative care: a systematic review of the literature. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 7:48-58. [PMID: 23911280 DOI: 10.1016/j.rpsm.2013.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
Abstract
Delirium in palliative care patients is common and its diagnosis and treatment is a major challenge. Our objective was to perform a literature analysis in two phases on the recent scientific evidence (2007-2012) on the diagnosis and treatment of delirium in adults receiving palliative care. In phase 1 (descriptive studies and narrative reviews) 133 relevant articles were identified: 73 addressed the issue of delirium secondarily, and 60 articles as the main topic. However, only 4 prospective observational studies in which delirium was central were identified. Of 135 articles analysed in phase 2 (clinical trials or descriptive studies on treatment of delirium in palliative care patients), only 3 were about prevention or treatment: 2 retrospective studies and one clinical trial on multicomponent prevention in cancer patients. Much of the recent literature is related to reviews on studies conducted more than a decade ago and on patients different to those receiving palliative care. In conclusion, recent scientific evidence on delirium in palliative care is limited and suboptimal. Prospective studies are urgently needed that focus specifically on this highly vulnerable population.
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Affiliation(s)
- Sofía Sánchez-Román
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Cristina Beltrán Zavala
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Argelia Lara Solares
- Clínica del Dolor y Cuidados Paliativos, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Erwin Chiquete
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Irwin SA, Pirrello RD, Hirst JM, Buckholz GT, Ferris FD. Clarifying delirium management: practical, evidenced-based, expert recommendations for clinical practice. J Palliat Med 2013; 16:423-35. [PMID: 23480299 PMCID: PMC3612281 DOI: 10.1089/jpm.2012.0319] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2013] [Indexed: 12/30/2022] Open
Abstract
Delirium is highly prevalent in those with serious or advanced medical illnesses. It is associated with many adverse consequences, including significant patient, family, and health care provider distress. This article suggests a novel approach to delirium assessment and management and provides useful, practical guidance for clinicians based on a complete review of the existing literature and the expert clinical opinion of the authors and their colleagues, derived from over a decade of collective bedside experience. Comprehensive assessment includes careful description of observed symptoms, signs, and behaviors; and an understanding of the patient's situation, including primary diagnosis, associated comorbidities, functional status, and prognosis. The importance of incorporating goals of care for the patient and family is discussed. The concepts of potential reversibility versus irreversible delirium and delirium subtype are proffered, with a description of how diagnostic and management strategies follow from these concepts. Pharmacological interventions that provide rapid, effective, and safe relief are presented. Employing both pharmacological and nonpharmacological interventions, including patient and family education, improves symptoms and relieves patient and family distress, whether the delirium is reversible or irreversible, hyperactive or hypoactive. All interventions can be provided in any setting of care, including patients' homes.
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Affiliation(s)
- Scott A Irwin
- San Diego Hospice and The Institute for Palliative Medicine, San Diego, CA 92103, USA.
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Na HS, Song IA, Park HS, Hwang JW, Do SH, Kim CS. Dexmedetomidine is effective for monitored anesthesia care in outpatients undergoing cataract surgery. Korean J Anesthesiol 2011; 61:453-9. [PMID: 22220220 PMCID: PMC3249565 DOI: 10.4097/kjae.2011.61.6.453] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 05/09/2011] [Accepted: 05/13/2011] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Dexmedetomidine has a sedative analgesic property without respiratory depression. This study evaluated the efficacy of dexmedetomidine as an appropriate sedative drug for monitored anesthesia care (MAC) in outpatients undergoing cataract surgery on both eyes compared with combination of propofol and alfentanil. METHODS Thirty-one eligible patients were randomly divided into two groups on the first operation day. Dexmedetomidine was administered in group D at 0.6 µg/kg/h, and propofol and alfentanil was infused concomitantly in group P at a rate of 2 mg/kg/h and 20 µg/kg/h, respectively. Sedation was titrated at Ramsay sedation score 3. Iowa satisfaction with anesthesia scale (ISAS) of the patients was evaluated postoperatively. Systolic blood pressure (SBP), heart rate (HR), respiration rate (RR), and peripheral oxygen saturation (SpO(2)) were recorded throughout the surgery. For the second operation, the group assignments were exchanged. RESULTS Postoperative ISAS was 50.3 (6.2) in group D and 42.7 (8.7) in group P, which was statistically significant (P < 0.001). SBP was significantly lower in group D compared with group P from the beginning of the operation. HR, RR, and SpO(2) were comparable between the two groups. There were 8 cases (25.8%) of hypertension in group P, and 1 case (3.2%) in group D (P < 0.05). In contrast, 1 case (3.2%) of hypotension and 1 case (3.2%) of bradycardia occurred in group D. CONCLUSIONS Compared with the combined use of propofol and alfentanil, dexmedetomidine could be used appropriately for MAC in cataract surgery with better satisfaction from the patients and a more stable cardiovascular state.
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Affiliation(s)
- Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Anaesthetic Management of a 1-Month-Old Puppy Undergoing Lateral Thoracotomy for Vascular Ring Anomaly Correction. Case Rep Vet Med 2011. [DOI: 10.1155/2011/536064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 1-month-old male flat-coated retriever was anaesthetized for correction of oesophageal constriction caused by a vascular ring anomaly. Anaesthesia was uneventfully induced with intravenous fentanyl, diazepam, and propofol and maintained with isoflurane in oxygen and air. An intercostal block with bupivacaine and lidocaine was performed, and additional analgesia with an infusion of fentanyl was provided. Fluid therapy consisted in 5% glucose in lactated Ringer’s solution and hetastarch 6%, which proved adequate to maintain normoglycemia and normovolemia. A lateral thoracotomy was performed, and the ligamentum arteriosum was ligated. Intraoperatively, heart rate (HR) varied between 120 and 180 beats min−1without accompanying changes in blood pressure. No arrhythmias were observed or bleeding occurred. The dog recovered uneventfully. Postoperative analgesia consisted in fentanyl infusion adjusted to the patient's requirement and metamizol. This paper describes for the first time the use of balanced anaesthesia and multimodal analgesia in a paediatric dog undergoing thoracotomy.
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