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Ripollés-Melchor J, Monge-García MI, Vincent JL. Dangers of misinterpreting intraoperative hypotension. Comments on Br J Anaesth 2023; 131: 823-31 and Br J Anaesth 2023; 131: 810-2. Br J Anaesth 2024; 132:802-803. [PMID: 38238197 DOI: 10.1016/j.bja.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Working Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Manuel I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Working Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain; Jerez de La Frontera University Hospital, Jerez de la Frontera, Spain
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2
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Cicekci F, Sargin M, Siki FO. How does circadian rhythm affect postoperative pain after pediatric acute appendicitis surgery? Anesth Pain Med (Seoul) 2024; 19:125-133. [PMID: 38725167 PMCID: PMC11089292 DOI: 10.17085/apm.23038] [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: 03/23/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the relationship between postoperative pain and circadian rhythm after pediatric acute appendicitis surgery. METHODS Two hundred patients, aged 6-18 years, undergoing acute appendicitis surgery were included in this prospective observational study. The patients were divided into four groups according to the time they underwent surgery: the night group, 01:01-07:00; morning group, 07:01-13:00; afternoon group, 13:01-19:00; and evening group, 19:01-01:00. Intraoperative and postoperative vital signs, postoperative 24-h Wong-Baker Faces Pain Rating Scale (FACEs) scores, and the amount of analgesic required were recorded. RESULTS A total of 186 patients were analyzed in the study. There was no statistically significant difference in the demographic characteristics of the patient groups. Additionally, no differences were observed in intraoperative and postoperative vital signs among the four groups. However, patients in the night group had significantly higher FACEs values than those in the other groups at each time point (1st, 3rd, 6th, and 12th h) up to 12 h (P = 0.007, P = 0.023, P = 0.048, and P = 0.003, respectively). The amount of analgesic required in the night group was statistically higher than in the other groups until 12 h (P = 0.002, P < 0.001, P = 0.002, and P = 0.004, respectively). CONCLUSIONS A relationship was found between acute appendicitis operations performed at night (01:01 to 07:00) under general anesthesia and circadian rhythm in children. We believe that considering circadian time in the relief of postoperative pain would be beneficial.
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Affiliation(s)
- Faruk Cicekci
- Department of Anesthesiology and Reanimation, Selcuk University School of Medicine, Konya, Türkiye
| | - Mehmet Sargin
- Department of Anesthesiology and Reanimation, Selcuk University School of Medicine, Konya, Türkiye
| | - Fatma Ozcan Siki
- Department of Anesthesiology and Reanimation, Selcuk University School of Medicine, Konya, Türkiye
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3
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Takahashi K, Sobczak F, Pais-Roldán P, Yu X. Characterizing brain stage-dependent pupil dynamics based on lateral hypothalamic activity. Cereb Cortex 2023; 33:10736-10749. [PMID: 37709360 PMCID: PMC10629899 DOI: 10.1093/cercor/bhad309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
Pupil dynamics presents varied correlation features with brain activity under different vigilant levels. The modulation of brain dynamic stages can arise from the lateral hypothalamus (LH), where diverse neuronal cell types contribute to arousal regulation in opposite directions via the anterior cingulate cortex (ACC). However, the relationship of the LH and pupil dynamics has seldom been investigated. Here, we performed local field potential (LFP) recordings at the LH and ACC, and whole-brain fMRI with simultaneous fiber photometry Ca2+ recording in the ACC, to evaluate their correlation with brain state-dependent pupil dynamics. Both LFP and functional magnetic resonance imaging (fMRI) data showed various correlations to pupil dynamics across trials that span negative, null, and positive correlation values, demonstrating brain state-dependent coupling features. Our results indicate that the correlation of pupil dynamics with ACC LFP and whole-brain fMRI signals depends on LH activity, suggesting a role of the latter in brain dynamic stage regulation.
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Affiliation(s)
- Kengo Takahashi
- High-Field Magnetic Resonance Department, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School (IMPRS), University of Tübingen, 72076 Tübingen, Germany
- Cognitive and Systems Neuroscience Group, Swammerdam Institute for Life Sciences, Faculty of Science, University of Amsterdam, 1098XH Amsterdam, The Netherlands
| | - Filip Sobczak
- High-Field Magnetic Resonance Department, Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany
| | - Patricia Pais-Roldán
- Medical Imaging Physics, Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich, 52425 Jülich, Germany
| | - Xin Yu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, United States
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4
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Manasova D, Stankovski T. Neural Cross-Frequency Coupling Functions in Sleep. Neuroscience 2023:S0306-4522(23)00227-0. [PMID: 37225051 DOI: 10.1016/j.neuroscience.2023.05.016] [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: 07/28/2022] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
The human brain presents a heavily connected complex system. From a relatively fixed anatomy, it can enable a vast repertoire of functions. One important brain function is the process of natural sleep, which alters consciousness and voluntary muscle activity. On neural level, these alterations are accompanied by changes of the brain connectivity. In order to reveal the changes of connectivity associated with sleep, we present a methodological framework for reconstruction and assessment of functional interaction mechanisms. By analyzing EEG (electroencephalogram) recordings from human whole night sleep, first, we applied a time-frequency wavelet transform to study the existence and strength of brainwave oscillations. Then we applied a dynamical Bayesian inference on the phase dynamics in the presence of noise. With this method we reconstructed the cross-frequency coupling functions, which revealed the mechanism of how the interactions occur and manifest. We focus our analysis on the delta-alpha coupling function and observe how this cross-frequency coupling changes during the different sleep stages. The results demonstrated that the delta-alpha coupling function was increasing gradually from Awake to NREM3 (non-rapid eye movement), but only during NREM2 and NREM3 deep sleep it was significant in respect of surrogate data testing. The analysis on the spatially distributed connections showed that this significance is strong only for within the single electrode region and in the front-to-back direction. The presented methodological framework is for the whole-night sleep recordings, but it also carries general implications for other global neural states.
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Affiliation(s)
- Dragana Manasova
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France; Université Paris Cité, Paris, France
| | - Tomislav Stankovski
- Faculty of Medicine, Ss Cyril and Methodius University, Skopje 1000, North Macedonia; Department of Physics, Lancaster University, Lancaster LA1 4YB, United Kingdom.
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5
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Altered Behavioral Responses Show GABA Sensitivity in Muscleblind-Like 2-Deficient Mice: Implications for CNS Symptoms in Myotonic Dystrophy. eNeuro 2022; 9:ENEURO.0218-22.2022. [PMID: 36150891 PMCID: PMC9557336 DOI: 10.1523/eneuro.0218-22.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 01/17/2023] Open
Abstract
Considerable evidence from mouse models and human postmortem brain suggests loss of Muscleblind-like protein 2 (MBNL2) function in brain is a major driver of CNS symptoms in Myotonic dystrophy type 1 (DM1). Increased hypersomnia, fatigue, and surgical complications associated with general anesthesia suggest possible sensitivity to GABAergic inhibition in DM1. To test the hypothesis that MBNL2 depletion leads to behavioral sensitivity to GABAA receptor (GABAA-R) modulation, Mbnl2 knock-out (KO) and wild-type (WT) littermates were treated with the anesthetic sevoflurane, the benzodiazepine diazepam, the imidazopyridine zolpidem, and the benzodiazepine rescue agent, flumazenil (Ro 15-1788), and assessed for various behavioral metrics. Mbnl2 KO mice exhibited delayed recovery following sevoflurane, delayed emergence and recovery from zolpidem, and enhanced sleep time at baseline that was modulated by flumazenil. A significantly higher proportion of Mbnl2 KO mice also loss their righting reflex [loss of righting reflex (LORR)] from a standard diazepam dose. We further examined whether MBNL2 depletion affects total GABAA-R mRNA subunit levels and validated RNA-sequencing data of mis-spliced Gabrg2, whose isoform ratios are known to regulate GABA sensitivity and associated behaviors. While no other GABAA-R subunit mRNA levels tested were altered in Mbnl2 KO mouse prefrontal cortex, Gabrg2S/L mRNA ratio levels were significantly altered. Taken together, our findings indicate that loss of MBNL2 function affects GABAergic function in a mouse model of myotonic dystrophy (DM1).
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Vacas S, Canales C, Deiner SG, Cole DJ. Perioperative Brain Health in the Older Adult: A Patient Safety Imperative. Anesth Analg 2022; 135:316-328. [PMID: 35584550 PMCID: PMC9288500 DOI: 10.1213/ane.0000000000006090] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
While people 65 years of age and older represent 16% of the population in the United States, they account for >40% of surgical procedures performed each year. Maintaining brain health after anesthesia and surgery is not only important to our patients, but it is also an increasingly important patient safety imperative for the specialty of anesthesiology. Aging is a complex process that diminishes the reserve of every organ system and often results in a patient who is vulnerable to the stress of surgery. The brain is no exception, and many older patients present with preoperative cognitive impairment that is undiagnosed. As we age, a number of changes occur in the human brain, resulting in a patient who is less resilient to perioperative stress, making older adults more susceptible to the phenotypic expression of perioperative neurocognitive disorders. This review summarizes the current scientific and clinical understanding of perioperative neurocognitive disorders and recommends patient-centered, age-focused interventions that can better mitigate risk, prevent harm, and improve outcomes for our patients. Finally, it discusses the emerging topic of sleep and cognitive health and other future frontiers of scientific inquiry that might inform clinical best practices.
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Affiliation(s)
- Susana Vacas
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Cecilia Canales
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Stacie G Deiner
- Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel J Cole
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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7
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Peciccia M, Buratta L, Ardizzi M, Germani A, Ayala G, Ferroni F, Mazzeschi C, Gallese V. Sense of self and psychosis, part 1: Identification, differentiation and the body; A theoretical basis for amniotic therapy. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2022. [DOI: 10.1080/0803706x.2021.1990401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Just N. Proton functional magnetic resonance spectroscopy in rodents. NMR IN BIOMEDICINE 2021; 34:e4254. [PMID: 31967711 DOI: 10.1002/nbm.4254] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/04/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
Proton functional magnetic resonance spectroscopy (1 H-fMRS) in the human brain is able to assess and quantify the metabolic response due to localized brain activity. Currently, 1 H-fMRS of the human brain is complementary to functional magnetic resonance imaging (fMRI) and a recommended technique at high field strengths (>7 T) for the investigation of neurometabolic couplings, thereby providing insight into the mechanisms underlying brain activity and brain connectivity. Understanding typical healthy brain metabolism during a task is expected to provide a baseline from which to detect and characterize neurochemical alterations associated with various neurological or psychiatric disorders and diseases. It is of paramount importance to resolve fundamental questions related to the regulation of neurometabolic processes. New techniques such as optogenetics may be coupled to fMRI and fMRS to bring more specificity to investigations of brain cell populations during cerebral activation thus enabling a higher link to molecular changes and therapeutic advances. These rather novel techniques are mainly available for rodent applications and trigger renewed interest in animal fMRS. However, rodent fMRS remains fairly confidential due to its inherent low signal-to-noise ratio and its dependence on anesthesia. For instance, the accurate determination of metabolic concentration changes during stimulation requires robust knowledge of the physiological environment of the measured region of interest linked to anesthesia in most cases. These factors may also have a strong influence on B0 homogeneity. Therefore, a degree of calibration of the stimulus strength and duration may be needed for increased knowledge of the underpinnings of cerebral activity. Here, we propose an early review of the current status of 1 H-fMRS in rodents and summarize current difficulties and future perspectives.
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Affiliation(s)
- Nathalie Just
- Department of Clinical Radiology, University Hospital Münster, Germany
- INRAE, Centre, Tours Val de Loire, France
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9
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Lobo FA, Vacas S, Rossetti AO, Robba C, Taccone FS. Does electroencephalographic burst suppression still play a role in the perioperative setting? Best Pract Res Clin Anaesthesiol 2020; 35:159-169. [PMID: 34030801 DOI: 10.1016/j.bpa.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022]
Abstract
With the widespread use of electroencephalogram [EEG] monitoring during surgery or in the Intensive Care Unit [ICU], clinicians can sometimes face the pattern of burst suppression [BS]. The BS pattern corresponds to the continuous quasi-periodic alternation between high-voltage slow waves [the bursts] and periods of low voltage or even isoelectricity of the EEG signal [the suppression] and is extremely rare outside ICU and the operative room. BS can be secondary to increased anesthetic depth or a marker of cerebral damage, as a therapeutic endpoint [i.e., refractory status epilepticus or refractory intracranial hypertension]. In this review, we report the neurophysiological features of BS to better define its role during intraoperative and critical care settings.
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Affiliation(s)
- Francisco Almeida Lobo
- Anesthesiology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Susana Vacas
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Reagan UCLA Medical Center, 757 Westwood Plaza #3325, Los Angeles, CA, 90095, USA.
| | - Andrea O Rossetti
- Department of Neurology, Lausanne University Hospital and University of Lausanne, CH-1011, Lausanne, Switzerland.
| | - Chiara Robba
- Azienda Ospedaliera Universitaria San Martino di Genova, Largo Rosanna Benzi,15, 16100, Genova, Italy.
| | - Fabio Silvio Taccone
- Hopital Érasme, Université Libre de Bruxelles, Department of Intensive Care Medicine, Route de Lennik, 808 1070, Brussels, Belgium.
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10
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Liu D, Li J, Wu J, Dai J, Chen X, Huang Y, Zhang S, Tian B, Mei W. Monochromatic Blue Light Activates Suprachiasmatic Nucleus Neuronal Activity and Promotes Arousal in Mice Under Sevoflurane Anesthesia. Front Neural Circuits 2020; 14:55. [PMID: 32973462 PMCID: PMC7461971 DOI: 10.3389/fncir.2020.00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/27/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Monochromatic blue light (MBL), with a wavelength between 400–490 nm, can regulate non-image-forming (NIF) functions of light in the central nervous system. The suprachiasmatic nucleus (SCN) in the brain is involved in the arousal-promoting response to blue light in mice. Animal and human studies showed that the responsiveness of the brain to visual stimuli is partly preserved under general anesthesia. Therefore, this study aimed to investigate whether MBL promotes arousal from sevoflurane anesthesia via activation of the SCN in mice. Methods: The induction and emergence time of sevoflurane anesthesia under MBL (460 nm and 800 lux) exposure was measured. Cortical electroencephalograms (EEGs) were recorded and the burst-suppression ratio (BSR) was calculated under MBL during sevoflurane anesthesia. The EEGs and local field potential (LFP) recordings with or without locally electrolytic ablated bilateral SCN were used to further explore the role of SCN in the arousal-promoting effect of MBL under sevoflurane anesthesia. Immunofluorescent staining of c-Fos was conducted to reveal the possible downstream mechanism of SCN activation. Results: Unlike the lack of effect on the induction time, MBL shortened the emergence time and the EEG recordings showed cortical arousal during the recovery period. MBL resulted in a significant decrease in BSR and a marked increase in EEG power at all frequency bands except for the spindle band during 2.5% sevoflurane anesthesia. MBL exposure under sevoflurane anesthesia enhances the neuronal activity of the SCN. These responses to MBL were abolished in SCN lesioned (SCNx) mice. MBL evoked a high level of c-Fos expression in the prefrontal cortex (PFC) and lateral hypothalamus (LH) compared to polychromatic white light (PWL) under sevoflurane anesthesia, while it exerted no effect on c-Fos expression in the ventrolateral preoptic area (VLPO) and locus coeruleus (LC) c-Fos expression. Conclusions: MBL promotes behavioral and electroencephalographic arousal from sevoflurane anesthesia via the activation of the SCN and its associated downstream wake-related nuclei. The clinical implications of this study warrant further study.
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Affiliation(s)
- Daiqiang Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiayi Wu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqi Dai
- Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Xinfeng Chen
- Chinese Institute for Brain Research (CIBR), ZGC Life Science Park, Beijing, China
| | - Yujie Huang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Tian
- Department of Neurobiology, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.,Key Laboratory of Neurological Diseases, Ministry of Education, Wuhan, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu D, Chen X, Huang Y, Zhang S, Wu J, Li J, Wang D, Tian B, Mei W. Acute continuous nocturnal light exposure decreases BSR under sevoflurane anesthesia in C57BL/6J mice: possible role of differentially spared light-sensitive pathways under anesthesia. Am J Transl Res 2020; 12:2843-2859. [PMID: 32655814 PMCID: PMC7344097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
Brain responses to external stimuli such as light are preserved under general anesthesia. In nocturnal animals, acute light exposure can induce sleep, and acute dark can increase wakefulness. This study aims to investigate the effect of acute continuous nocturnal light exposure (ACNLE) on burst-suppression patterns under sevoflurane anesthesia using electroencephalogram (EEG) monitoring in mice. We set the initial sevoflurane dose to 2.0% and increased it by 0.5% every 20 min until it reached 4.0%. Burst-suppression ratio (BSR), EEG power and quantitative burst analysis were used to assess the effects of ACNLE on burst suppression patterns under sevoflurane anesthesia. Blood serum corticosterone measurement and c-Fos immunofluorescent staining of the suprachiasmatic nucleus (SCN) and ventrolateral preoptic nucleus (VLPO) were used to demonstrate the biological consequence induced by ACNLE. Compared to darkness, ACNLE caused significant changes in EEG power and decrease of BSR at 2.5%, 3.0% and 3.5% sevoflurane. ACNLE was also associated with an increase in burst duration and burst frequency as well as a decrease in burst maximum peak-to-peak amplitude and burst power in the beta (15-25 Hz) and gamma (25-80 Hz) bands. ACNLE increased the concentration of serum corticosterone and the expression of c-Fos in the SCN, while not changed c-Fos expression in the VLPO. These results demonstrated that ACNLE influences the BSR under sevoflurane anesthesia, possibly by activating light-sensitive nonvisual pathways including SCN and increasing of peripheral serum corticosterone levels.
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Affiliation(s)
- Daiqiang Liu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Xinfeng Chen
- Chinese Institute for Brain ResearchBeijing (CIBR) No. 26 Science Park Road, ZGC Life Science Park, Changping District, Beijing 100085, China
| | - Yujie Huang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Shuang Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Jiayi Wu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Jiayan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Dan Wang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
| | - Bo Tian
- Department of Neurobiology, Tongji Medical School, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
- Key Laboratory of Neurological Diseases, Ministry of Education13 Hangkong Road, Wuhan 430030, Hubei Province, China
| | - Wei Mei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan 430030, Hubei Province, China
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12
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Hadjihambi A, Karagiannis A, Theparambil SM, Ackland GL, Gourine AV. The effect of general anaesthetics on brain lactate release. Eur J Pharmacol 2020; 881:173188. [PMID: 32439258 PMCID: PMC7456770 DOI: 10.1016/j.ejphar.2020.173188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022]
Abstract
The effects of anaesthetic agents on brain energy metabolism may explain their shared neurophysiological actions but remain poorly understood. The brain lactate shuttle hypothesis proposes that lactate, provided by astrocytes, is an important neuronal energy substrate. Here we tested the hypothesis that anaesthetic agents impair the brain lactate shuttle by interfering with astrocytic glycolysis. Lactate biosensors were used to record changes in lactate release by adult rat brainstem and cortical slices in response to thiopental, propofol and etomidate. Changes in cytosolic nicotinamide adenine dinucleotide reduced (NADH) and oxidized (NAD+) ratio as a measure of glycolytic rate were recorded in cultured astrocytes. It was found that in brainstem slices thiopental, propofol and etomidate reduced lactate release by 7.4 ± 3.6% (P < 0.001), 9.7 ± 6.6% (P < 0.001) and 8.0 ± 7.8% (P = 0.04), respectively. In cortical slices, thiopental reduced lactate release by 8.2 ± 5.6% (P = 0.002) and propofol by 6.0 ± 4.5% (P = 0.009). Lactate release in cortical slices measured during the light phase (period of sleep/low activity) was ~25% lower than that measured during the dark phase (period of wakefulness) (326 ± 83 μM vs 430 ± 118 μM, n = 10; P = 0.04). Thiopental and etomidate induced proportionally similar decreases in cytosolic [NADH]:[NAD+] ratio in astrocytes, indicative of a reduction in glycolytic rate. These data suggest that anaesthetic agents inhibit astrocytic glycolysis and reduce the level of extracellular lactate in the brain. Similar reductions in brain lactate release occur during natural state of sleep, suggesting that general anaesthesia may recapitulate some of the effects of sleep on brain energy metabolism.
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Affiliation(s)
- Anna Hadjihambi
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK; Department of Biomedical Sciences, University of Lausanne, Lausanne, 1005, Switzerland.
| | - Anastassios Karagiannis
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Shefeeq M Theparambil
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
| | - Gareth L Ackland
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Alexander V Gourine
- Centre for Cardiovascular and Metabolic Neuroscience, Neuroscience, Physiology and Pharmacology, University College London, London, WC1E 6BT, UK
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Abstract
PURPOSE OF REVIEW The alteration of circadian rhythms in the postoperative period has been demonstrated to influence the outcomes. With this narrative review we would revise how anesthesia, surgery and intensive care can interfere with the circadian clock, how this could impact on the postsurgical period and how to limit the disruption of the internal clock. RECENT FINDINGS Anesthesia affects the clock in relation to the day-time administration and the type of anesthetics, N-methyl-D-aspartate receptor antagonists or gamma-aminobutyric acid receptors agonists. Surgery causes stress and trauma with consequent alteration in the circadian release of cortisol, cytokines and melatonin. ICU represents a further challenge for the patient internal clock because of sedation, immobility, mechanical ventilation and alarms noise. SUMMARY The synergic effect of anesthesia, surgery and postoperative intensive care on circadian rhythms require a careful approach to the patient considering a role for therapies and interventions aimed to re-establish the normal circadian rhythms. Over time, approach like the Awakening and Breathing Coordination, Delirium Monitoring and Management, Early Mobility and Family engagement and empowerment bundle can implement the clinical practice.
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14
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Stanciu AE, Zamfir-Chiru-Anton A, Stanciu MM, Pantea-Stoian A, Nitipir C, Gheorghe DC. Serum melatonin is inversely associated with matrix metalloproteinase-9 in oral squamous cell carcinoma. Oncol Lett 2020; 19:3011-3020. [PMID: 32218858 DOI: 10.3892/ol.2020.11392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/12/2019] [Indexed: 12/13/2022] Open
Abstract
Matrix-metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) expression levels have been demonstrated to have prognostic value in oral squamous cell carcinoma (OSCC). The present study hypothesized that melatonin, a small lipophilic molecule primarily secreted by the pineal gland, may be able to regulate MMP activity in OSCC progression. This study aimed to investigate the associations between melatonin, MMPs, TIMPs and the histopathological characteristics of patients with OSCC. A total of 40 men with OSCC (mean age, 57±7 years) and 30 healthy men (mean age, 56±5 years) were enrolled in the present study. Enzyme immunoassays were used to measure the serum levels of melatonin, MMP-9, MMP-2, TIMP-1 and TIMP-2 before and after transoral surgery for OSCC. Serum melatonin level was significantly lower in patients with OSCC compared with controls, both pre-surgery and 2 days after surgery (P<0.001). In addition, melatonin level was negatively correlated with MMP-9 (r=-0.6371) and the MMP-9/TIMP-1 ratio (r=-0.4700), but not with the MMP-2 or MMP-2/TIMP-2 ratio, in patients with OSCC. These results demonstrated that low levels of melatonin and high levels of MMP-9 correlated with large tumors with invasive depth (r=-0.35 and r=0.33) and lymph node metastasis (r=-0.56 and r=0.34). The results of this retrospective clinical study suggested that melatonin may be considered as a predictive biomarker of tumor growth and metastasis and a potential therapeutic agent for patients with OSCC.
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Affiliation(s)
- Adina Elena Stanciu
- Department of Carcinogenesis and Molecular Biology, Institute of Oncology Bucharest, Bucharest 022328, Romania
| | - Adina Zamfir-Chiru-Anton
- ENT Department, Grigore Alexandrescu Children's Emergency Hospital and Coltea Clinical Hospital, Bucharest 011743, Romania
| | - Marcel Marian Stanciu
- Electrical Engineering Faculty, Politehnica University of Bucharest, Bucharest 060042, Romania
| | - Anca Pantea-Stoian
- Department of Hygiene, Carol Davila University of Medicine and Pharmacy, Bucharest 050474, Romania
| | - Cornelia Nitipir
- Department of Medical Oncology, Elias University Emergency Hospital, Bucharest 011461, Romania
| | - Dan Cristian Gheorghe
- ENT Department, Maria Sklodowska Curie Children's Emergency Hospital, Bucharest 077120, Romania
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Wang S, Li Y, Qiu S, Zhang C, Wang G, Xian J, Li T, He H. Reorganization of rich-clubs in functional brain networks during propofol-induced unconsciousness and natural sleep. NEUROIMAGE-CLINICAL 2020; 25:102188. [PMID: 32018124 PMCID: PMC6997627 DOI: 10.1016/j.nicl.2020.102188] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/31/2019] [Accepted: 01/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND General anesthesia (GA) provides an invaluable experimental tool to understand the essential neural mechanisms underlying consciousness. Previous neuroimaging studies have shown the functional integration and segregation of brain functional networks during anesthetic-induced alteration of consciousness. However, the organization pattern of hubs in functional brain networks remains unclear. Moreover, comparisons with the well-characterized physiological unconsciousness can help us understand the neural mechanisms of anesthetic-induced unconsciousness. METHODS Resting-state functional magnetic resonance imaging was performed during wakefulness, mild propofol-induced sedation (m-PIS), and deep PIS (d-PIS) with clinical unconsciousness on 8 healthy volunteers and wakefulness and natural sleep on 9 age- and sex-matched healthy volunteers. Large-scale functional brain networks of each volunteer were constructed based on 160 regions of interest. Then, rich-club organizations in brain functional networks and nodal properties (nodal strength and efficiency) were assessed and analyzed among the different states and groups. RESULTS Rich-clubs in the functional brain networks were reorganized during alteration of consciousness induced by propofol. Firstly, rich-club nodes were switched from the posterior cingulate cortex (PCC), angular gyrus, and anterior and middle insula to the inferior parietal lobule (IPL), inferior parietal sulcus (IPS), and cerebellum. When sedation was deepened to unconsciousness, the rich-club nodes were switched to the occipital and angular gyrus. These results suggest that the rich-club nodes were switched among the high-order cognitive function networks (default mode network [DMN] and fronto-parietal network [FPN]), sensory networks (occipital network [ON]), and cerebellum network (CN) from consciousness (wakefulness) to propofol-induced unconsciousness. At the same time, compared with wakefulness, local connections were switched to rich-club connections during propofol-induced unconsciousness, suggesting a strengthening of the overall information commutation of networks. Nodal efficiency of the anterior and middle insula and ventral frontal cortex was significantly decreased. Additionally, from wakefulness to natural sleep, a similar pattern of rich-club reorganization with propofol-induced unconsciousness was observed: rich-club nodes were switched from the DMN (including precuneus and PCC) to the sensorimotor network (SMN, including part of the frontal and temporal gyrus). Compared with natural sleep, nodal efficiency of the insula, frontal gyrus, PCC, and cerebellum significantly decreased during propofol-induced unconsciousness. CONCLUSIONS Our study demonstrated that the rich-club reorganization in functional brain networks is characterized by switching of rich-club nodes between the high-order cognitive and sensory and motor networks during propofol-induced alteration of consciousness and natural sleep. These findings will help understand the common neurological mechanism of pharmacological and physiological unconsciousness.
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Affiliation(s)
- Shengpei Wang
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Yun Li
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuang Qiu
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chuncheng Zhang
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Guyan Wang
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tianzuo Li
- Department of Anesthesia, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Huiguang He
- Research Center for Brain-inspired Intelligence and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China.
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16
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Proekt A, Hudson AE. A stochastic basis for neural inertia in emergence from general anaesthesia. Br J Anaesth 2018; 121:86-94. [PMID: 29935600 DOI: 10.1016/j.bja.2018.02.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/23/2018] [Accepted: 03/05/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transitions into and out of the anaesthetised state exhibit resistance to state transitions known as neural inertia. As a consequence, emergence from anaesthesia occurs at a consistently lower anaesthetic concentration than induction. Motivated by stochastic switching between discrete activity patterns observed at constant anaesthetic concentration, we investigated the consequences of such switching for neural inertia. METHODS We simulated stochastic switching in MATLAB as Brownian motion on an energy landscape or equivalently as a discrete Markov process. Effects of anaesthetics were modelled as changing stability of the awake and the anaesthetised states. Simulation results were compared with re-analysed neural inertia data from mice and Drosophila. RESULTS Diffusion on a two-well energy landscape gives rise to hysteresis. With additive noise, hysteresis collapses. This collapse occurs over a mixing time that is independent from pharmacokinetics. The two-well potential gives rise to the leftward shift for the emergence dose-response curve. Yet, from in vivo data, ΔEC50 and Δ Hill slope are strongly negatively correlated (R2=0.45, P<1.7×10-15). This correlation is not explained by a two-well potential. The extension of the diffusion model to a Markov process with 10 states (three awake, seven unconscious) reproduces both the left shift and the shallower Hill slope for emergence. CONCLUSIONS Stochastic state switching accounts for all known features of neural inertia. More than two states are required to explain the consistent increase observed in variability of recovery from general anaesthesia. This model predicts that hysteresis should collapse with a time scale independent of anaesthetic drug pharmacokinetics.
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Affiliation(s)
- A Proekt
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - A E Hudson
- Department of Anesthesiology and Perioperative Medicine, UCLA, Los Angeles, CA, USA
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