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Camporesi A, Roveri G, Vetrugno L, Buonsenso D, De Giorgis V, Costanzo S, Pierucci UM, Pelizzo G. Lung ultrasound assessment of atelectasis following different anesthesia induction techniques in pediatric patients: a propensity score-matched, observational study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:69. [PMID: 39369249 DOI: 10.1186/s44158-024-00206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/30/2024] [Indexed: 10/07/2024]
Abstract
INTRODUCTION Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS). METHODS This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis. RESULTS Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21-8.58; p < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis. DISCUSSION Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT06069414.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy.
| | - Giulia Roveri
- Department of Anesthesia and Intensive Care Medicine "F. Tappeiner" Hospital, Merano, Italy
- Eurac Research, Institute of Mountain Emergency Medicine, 39100, Bolzano, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", Rome, Italy
- Centro Di Salute Globale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina De Giorgis
- Department of Pediatric Anesthesia and Intensive Care, Buzzi Children's Hospital, Via Castelvetro 32, 20154, Milan, Italy
| | - Sara Costanzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children's Hospital, Milan, Italy
- Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
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Garcia MJ, Amarelle L, Malacrida L, Briva A. Novel opportunities from bioimaging to understand the trafficking and maturation of intracellular pulmonary surfactant and its role in lung diseases. Front Immunol 2023; 14:1250350. [PMID: 37638003 PMCID: PMC10448512 DOI: 10.3389/fimmu.2023.1250350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Pulmonary surfactant (PS), a complex mixture of lipids and proteins, is essential for maintaining proper lung function. It reduces surface tension in the alveoli, preventing collapse during expiration and facilitating re-expansion during inspiration. Additionally, PS has crucial roles in the respiratory system's innate defense and immune regulation. Dysfunction of PS contributes to various respiratory diseases, including neonatal respiratory distress syndrome (NRDS), adult respiratory distress syndrome (ARDS), COVID-19-associated ARDS, and ventilator-induced lung injury (VILI), among others. Furthermore, PS alterations play a significant role in chronic lung diseases such as chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). The intracellular stage involves storing and releasing a specialized subcellular organelle known as lamellar bodies (LB). The maturation of these organelles requires coordinated signaling to organize their intracellular organization in time and space. LB's intracellular maturation involves the lipid composition and critical processing of surfactant proteins to achieve proper functionality. Over a decade ago, the supramolecular organization of lamellar bodies was studied using electron microscopy. In recent years, novel bioimaging tools combining spectroscopy and microscopy have been utilized to investigate the in cellulo intracellular organization of lamellar bodies temporally and spatially. This short review provides an up-to-date understanding of intracellular LBs. Hyperspectral imaging and phasor analysis have allowed identifying specific transitions in LB's hydration, providing insights into their membrane dynamics and structure. A discussion and overview of the latest approaches that have contributed to a new comprehension of the trafficking and structure of lamellar bodies is presented.
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Affiliation(s)
- María José Garcia
- Unidad Academica de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Advanced Bioimaging Unit, Institut Pasteur de Montevideo & Universidad de la República, Montevideo, Uruguay
| | - Luciano Amarelle
- Unidad Academica de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Advanced Bioimaging Unit, Institut Pasteur de Montevideo & Universidad de la República, Montevideo, Uruguay
- Unidad Academica de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Leonel Malacrida
- Unidad Academica de Fisiopatología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
- Advanced Bioimaging Unit, Institut Pasteur de Montevideo & Universidad de la República, Montevideo, Uruguay
| | - Arturo Briva
- Unidad Academica de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Zhao X, Song Q, Wang Y, Zhang Q, Sun C. Dexmedetomidine improves lung compliance in patients undergoing lateral decubitus position of shoulder arthroscopy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33661. [PMID: 37083765 PMCID: PMC10118338 DOI: 10.1097/md.0000000000033661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The improvement of oxygenation and pulmonary mechanics in patients under general anesthesia can be achieved by dexmedetomidine (DEX) infusion. However, its role in patients undergoing lateral supine shoulder arthroscopy has not been thoroughly studied. This study aimed to evaluate the effect of DEX on lung compliance in patients undergoing shoulder arthroscopic surgery in a lateral decubitus position. METHODS The patients who underwent lateral recumbent shoulder arthroscopy under general anesthesia were randomly divided into the DEX group (group D) and the control group (group N). At the start of the trial, group D was given 0.5 μg/kg/hours continuous pumping until 30 minutes before the end of anesthesia; Group N was injected with normal saline at the same volume. The patients were recorded at each time point after intubation: supine position for 5 minutes (T0), lateral position for 5 minutes (T1), lateral position for 1 hour (T2), lateral position for 2 hours (T3), airway peak pressure, platform pressure, dynamic lung compliance, and static lung compliance, etc. RESULTS At the end of the drug infusion, the DEX group showed significant improved pulmonary mechanics and higher lung compliance than the control group. Compared with group N, group D's heart rate and mean arterial pressure were lower at all time points; there was no statistical difference in Tidal volume and Pressure end-tidal carbon dioxide data at each time point in Group D. CONCLUSION DEX can improve lung compliance and reduce airway pressure and platform pressure of patients undergoing shoulder arthroscopy in the lateral position under general anesthesia.
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Affiliation(s)
- Xiujie Zhao
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Qianqian Song
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Yewen Wang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Quanyi Zhang
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Chao Sun
- Department of Anesthesiology, Binzhou Medical University Hospital, Binzhou, Shandong, China
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Machado-Junior PA, de Souza ABF, Castro TDF, Perucci LO, Talvani A, Cangussú SD, Bezerra FS. The deleterious impact of exposure to different inhaled anesthetics is time dependent. Life Sci 2022; 309:121004. [PMID: 36170891 DOI: 10.1016/j.lfs.2022.121004] [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: 08/02/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022]
Abstract
In this study, the effects of exposure to isoflurane, sevoflurane and desflurane on the oxidative response and inflammation at different times was analyzed in the lungs of adult C57BL/6 mice. 120 animals were divided into 3 groups (n = 40): Isoflurane (ISO), Sevoflurane (SEV) and Desflurane (DES) and exposed to these anesthetics for 1 h (n = 10), 2 h (n = 10) and 3 h (n = 10), at a minimum alveolar concentration (MAC) equal to 1. The control group (CG) (n = 10) was exposed to ambient air. 24 h after the experimental protocol, the animals were euthanized and the bronchoalveolar lavage fluid (BALF), blood and lung tissue samples were collected. In the BALF, animals exposed to isoflurane for 2 h and 3 h showed a greater influx of leukocytes, especially macrophages compared to the CG. The ISO3h had lower leukocyte counts in the peripheral blood compared to CG, ISO1h and ISO2h. There was an increase in CCL-2 levels in the ISO3h compared to the CG. Superoxide dismutase activity was higher in ISO1h compared to CG. The activity of catalase was higher in the ISO1h and ISO2h compared to the CG. The lipid peroxidation, as well as carbonylated protein were higher in the ISO3h compared to the CG (p < 0.05). Similar results were observed in the exposure of SEV and DES compared to inflammation and redox imbalance in different periods. This study demonstrated that time is a determinant to promote a local and systemic inflammatory response to different inhalational anesthetics in a healthy murine model.
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Affiliation(s)
- Pedro Alves Machado-Junior
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Centre of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - Ana Beatriz Farias de Souza
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Centre of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - Thalles de Freitas Castro
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Centre of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - Luiza Oliveira Perucci
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences, Institute of Physics and Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - André Talvani
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences, Institute of Physics and Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - Silvia Dantas Cangussú
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Centre of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil
| | - Frank Silva Bezerra
- Laboratory of Experimental Pathophysiology, Department of Biological Sciences and Centre of Research in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto 35400-000, Brazil.
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Fröhlich E. Non-Cellular Layers of the Respiratory Tract: Protection against Pathogens and Target for Drug Delivery. Pharmaceutics 2022; 14:pharmaceutics14050992. [PMID: 35631578 PMCID: PMC9143813 DOI: 10.3390/pharmaceutics14050992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 12/10/2022] Open
Abstract
Epithelial barriers separate the human body from the environment to maintain homeostasis. Compared to the skin and gastrointestinal tract, the respiratory barrier is the thinnest and least protective. The properties of the epithelial cells (height, number of layers, intercellular junctions) and non-cellular layers, mucus in the conducting airways and surfactant in the respiratory parts determine the permeability of the barrier. The review focuses on the non-cellular layers and describes the architecture of the mucus and surfactant followed by interaction with gases and pathogens. While the penetration of gases into the respiratory tract is mainly determined by their hydrophobicity, pathogens use different mechanisms to invade the respiratory tract. Often, the combination of mucus adhesion and subsequent permeation of the mucus mesh is used. Similar mechanisms are also employed to improve drug delivery across the respiratory barrier. Depending on the payload and target region, various mucus-targeting delivery systems have been developed. It appears that the mucus-targeting strategy has to be selected according to the planned application.
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Affiliation(s)
- Eleonore Fröhlich
- Center for Medical Research, Medical University of Graz, 8010 Graz, Austria; ; Tel.: +43-316-38573011
- Research Center Pharmaceutical Engineering GmbH, 8010 Graz, Austria
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Chírico MTT, Guedes MR, Vieira LG, Reis TO, Dos Santos AM, Souza ABF, Ribeiro IML, Noronha SISR, Nogueira KO, Oliveira LAM, Gomes FAR, Silva FC, Chianca-Jr DA, Bezerra FS, de Menezes RCA. Lasting effects of ketamine and isoflurane administration on anxiety- and panic-like behavioral responses in Wistar rats. Life Sci 2021; 276:119423. [PMID: 33785344 DOI: 10.1016/j.lfs.2021.119423] [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: 11/30/2020] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
In clinical and laboratory practice, the use of anesthetics is essential in order to perform surgeries. Anesthetics, besides causing sedation and muscle relaxation, promote several physiological outcomes, such as psychotomimetic alterations, increased heart rate, and blood pressure. However, studies depicting the behavioral effect induced by ketamine and isoflurane are conflicting. In the present study, we assessed the behavioral effects precipitated by ketamine and isoflurane administration. We have also evaluated the ketamine effect on cell cytotoxicity and viability in an amygdalar neuronal primary cell culture. Ketamine (80 mg/kg) caused an anxiogenic effect in rats exposed to the elevated T-maze test (ETM) 2 and 7 days after ketamine administration. Ketamine (40 and 80 mg/kg) administration also decreased panic-like behavior in the ETM. In the light/dark test, ketamine had an anxiogenic effect. Isoflurane did not change animal behavior on the ETM. Neither ketamine nor isoflurane changed the spontaneous locomotor activity in the open field test. However, isoflurane-treated animals explored less frequently the OF central area seven days after treatment. Neither anesthetic caused oxidative damage in the liver. Ketamine also reduced cellular metabolism and led to neuronal death in amygdalar primary cell cultures. Thus, our work provides evidence that ketamine and isoflurane induce pronounced long lasting anxiety-related behaviors in male rats.
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Affiliation(s)
- Máira Tereza Talma Chírico
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Mariana Reis Guedes
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Lucas Gabriel Vieira
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Thayane Oliveira Reis
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Aline Maria Dos Santos
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Ana Beatriz Farias Souza
- Department of Biological Sciences, Laboratory of Experimental Pathophysiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Iara Mariana Léllis Ribeiro
- Department of Biological Sciences, Laboratory of Biomaterials and Experimental Pathology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Sylvana I S R Noronha
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Katiane O Nogueira
- Department of Biological Sciences, Laboratory of Biomaterials and Experimental Pathology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Laser Antonio Machado Oliveira
- Department of Biological Sciences, Laboratory of Biomaterials and Experimental Pathology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Fabiana Aparecida Rodrigues Gomes
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil
| | - Fernanda Cacilda Silva
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Deoclécio Alves Chianca-Jr
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Frank Silva Bezerra
- Department of Biological Sciences, Laboratory of Experimental Pathophysiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
| | - Rodrigo Cunha Alvim de Menezes
- Department of Biological Sciences, Laboratory of Cardiovascular Physiology, Federal University of Ouro Preto, Ouro Preto, MG 35400-000, Brazil.
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Jo Y, Hwang J, Lee J, Kang H, Hong B. Negative-pressure-related diffuse alveolar hemorrhage after monitored anesthesia care for vertebroplasty: a case report. J Med Case Rep 2021; 15:137. [PMID: 33722271 PMCID: PMC7962387 DOI: 10.1186/s13256-021-02697-6] [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: 12/25/2020] [Accepted: 01/27/2021] [Indexed: 11/23/2022] Open
Abstract
Background Diffuse alveolar hemorrhage (DAH) is a rare, life-threatening condition that can present as a spectrum of nonspecific symptoms, ranging from cough, dyspnea, and hemoptysis to severe hypoxemic respiratory failure. Perioperative DAH is frequently caused by negative pressure pulmonary edema resulting from acute airway obstruction, such as laryngospasm, although hemorrhage itself is rare. Case presentation This case report describes an unexpected hemoptysis following monitored anesthesia care for vertebroplasty. A 68-year-old Asian woman, with a compression fracture of the third lumbar vertebra was admitted for vertebroplasty. There were no noticeable events during the procedure. After the procedure, the patient was transferred to the postanesthesia care unit (PACU), at which sudden hemoptysis occurred. The suspected airway obstruction may have developed during transfer or immediate arrive in PACU. In postoperative chest x-ray, newly formed perihilar consolidation observed in both lung fields. The patients was transferred to a tertiary medical institution for further evaluation. She diagnosed with DAH for hemoptysis, new pulmonary infiltrates on chest x-ray and anemia. The patient received supportive care and discharged without further events. Conclusions Short duration of airway obstruction may cause DAH, it should be considered in the differential diagnosis of postoperative hemoptysis of unknown etiology.
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Affiliation(s)
- Yumin Jo
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Jagyung Hwang
- Department of Anesthesiology and Pain Medicine, Daejeon Woori Hospital, Daejeon, South Korea
| | - Jieun Lee
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Hansol Kang
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Boohwi Hong
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.
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Riveros-Perez E, Riveros R. Water in the human body: An anesthesiologist's perspective on the connection between physicochemical properties of water and physiologic relevance. Ann Med Surg (Lond) 2017; 26:1-8. [PMID: 29904607 PMCID: PMC5904784 DOI: 10.1016/j.amsu.2017.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/10/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
The unique structure and multifaceted physicochemical properties of the water molecule, in addition to its universal presence in body compartments, make water a key player in multiple biological processes in human physiology. Since anesthesiologists deal with physiologic processes where water molecules are critical at different levels, and administer medications whose pharmacokinetics and pharmacodynamics depend on interaction with water molecules, we consider that exploration of basic science aspects related to water and its role in physiology and pharmacology is relevant to the practice of anesthesiology. The purpose of this paper is to delineate the physicochemical basis of water that are critical in enabling it to support various homeostatic processes. The role of water in the formation of solutions, modulation of surface tension and in homeostasis of body temperature, acid-base status and osmolarity, is analyzed. Relevance of molecular water interactions to the anesthesiologist is not limited to the realm of physiology and pathophysiology. Deep knowledge of the importance of water in volatile anesthetic effects on neurons opens a window to a new comprehensive understanding of complex cellular mechanisms underlying the practice of anesthesiology.
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Affiliation(s)
- Efraín Riveros-Perez
- Department of Anesthesiology and Perioperative Medicine, Augusta University, USA
| | - Ricardo Riveros
- Pediatric Anesthesiologist Nemours Children's Health System, Orlando, FL, USA
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Trachsel D, Svendsen J, Erb T, von Ungern-Sternberg B. Effects of anaesthesia on paediatric lung function. Br J Anaesth 2016; 117:151-63. [DOI: 10.1093/bja/aew173] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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