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Mosneag IE, Flaherty SM, Wykes RC, Allan SM. Stroke and Translational Research - Review of Experimental Models with a Focus on Awake Ischaemic Induction and Anaesthesia. Neuroscience 2024; 550:89-101. [PMID: 38065289 DOI: 10.1016/j.neuroscience.2023.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
Animal models are an indispensable tool in the study of ischaemic stroke with hundreds of drugs emerging from the preclinical pipeline. However, all of these drugs have failed to translate into successful treatments in the clinic. This has brought into focus the need to enhance preclinical studies to improve translation. The confounding effects of anaesthesia on preclinical stroke modelling has been raised as an important consideration. Various volatile and injectable anaesthetics are used in preclinical models during stroke induction and for outcome measurements such as imaging or electrophysiology. However, anaesthetics modulate several pathways essential in the pathophysiology of stroke in a dose and drug dependent manner. Most notably, anaesthesia has significant modulatory effects on cerebral blood flow, metabolism, spreading depolarizations, and neurovascular coupling. To minimise anaesthetic complications and improve translational relevance, awake stroke induction has been attempted in limited models. This review outlines anaesthetic strategies employed in preclinical ischaemic rodent models and their reported cerebral effects. Stroke related complications are also addressed with a focus on infarct volume, neurological deficits, and thrombolysis efficacy. We also summarise routinely used focal ischaemic stroke rodent models and discuss the attempts to induce some of these models in awake rodents.
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Affiliation(s)
- Ioana-Emilia Mosneag
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom.
| | - Samuel M Flaherty
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Robert C Wykes
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Stuart M Allan
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
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2
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Wang J, Zhu L, Li C, Lin Y, Wang B, Lin X, Bi Y. The relationship between intraoperative hypothermia and postoperative delirium: The PNDRFAP study. Brain Behav 2024; 14:e3512. [PMID: 38747874 PMCID: PMC11095299 DOI: 10.1002/brb3.3512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/16/2024] [Accepted: 04/13/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Our study aimed to investigate the correlation between intraoperative hypothermia and postoperative delirium (POD) in patients undergoing general anesthesia for gastrointestinal surgery. METHODS The study comprised 750 participants from the Perioperative Neurocognitive Disorder Risk Factor and Prognosis (PNDRFAP) study database, which ultimately screened 510 individuals in the final analysis. Preoperative cognitive function was evaluated using the Mini-Mental State Examination (MMSE). The occurrence of POD was determined using the Confusion Assessment Method, and the severity of POD was evaluated using the Memorial Delirium Assessment Scale. Logistic regression was employed to scrutinize the association between intraoperative hypothermia and the incidence of POD, and the sensitivity analysis was conducted by introducing adjusted confounding variables. Decision curves and a nomogram model were utilized to assess the predictive efficacy of intraoperative hypothermia for POD. Mediation analysis involving 10,000 bootstrapped iterations was employed to appraise the suggested mediating effect of numeric rating scale (NRS) scores at 24 and 48 h post-surgeries. The receiver-operating characteristic (ROC) was utilized to evaluate the effectiveness of intraoperative hypothermia in predicting POD. RESULTS In the PNDRFAP study, the occurrence of POD was notably higher in the intraoperative hypothermia group (62.2%) compared to the intraoperative normal body temperature group (9.8%), with an overall POD incidence of 17.6%. Logistic regression analysis, adjusted for various confounding factors (age [40-90], gender, education, MMSE, smoking history, drinking history, hypertension, diabetes, and the presence of cardiovascular heart disease), demonstrated that intraoperative hypothermia significantly increased the risk of POD (OR = 4.879, 95% CI = 3.020-7.882, p < .001). Mediation analyses revealed that the relationship between intraoperative hypothermia and POD was partially mediated by NRS 24 h after surgery, accounting for 14.09% of the association (p = .002). The area under the curve of the ROC curve was 0.685, which confirmed that intraoperative hypothermia could predict POD occurrence to a certain extent. Decision curve and nomogram analyses, conducted using the R package, further substantiated the predictive efficacy of intraoperative hypothermia on POD. CONCLUSION Intraoperative hypothermia may increase the risk of POD, and this association may be partially mediated by NRS scores 24 h after surgery.
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Affiliation(s)
- Jiahan Wang
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
| | - Lei Zhu
- Department of Medical Scientific ResearchQingdao Municipal HospitalQingdaoChina
| | - Chuan Li
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
| | - Yanan Lin
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
| | - Bin Wang
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
| | - Xu Lin
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
| | - Yanlin Bi
- Department of AnesthesiologyQingdao Municipal HospitalQingdaoChina
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3
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Sunjoyo A, Nugroho A. Neuroprotective Agents: A Simple Overview. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuroprotective agents are medications that can alter the course of metabolic events and have neuroprotective function. Neuroprotective agents are needed in patients undergoing a surgical procedure and clinical conditions that correspond with the central nervous system (CNS); also, in intensive care, the neuroprotective agents are often used to prevent complications and patient deterioration. Over the years, there is still no clear understanding of the potential for neuroprotection and the interactions between various drugs that serve a crucial role in anesthetic care and critical illness. This literature review will discuss further the mechanism of neuronal damage and various neuroprotective agents.
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The surgical management of intraoperative intracranial internal carotid artery injury in open skull base surgery-a systematic review. Neurosurg Rev 2021; 45:1263-1273. [PMID: 34802074 DOI: 10.1007/s10143-021-01692-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 01/25/2023]
Abstract
Intraoperative internal carotid artery (ICA) injury during open skull base surgery is a catastrophic complication. Multiple techniques and management strategies have been reported for endoscopic skull base surgery; however, the literature on managing this complication in open skull base surgery is limited. To perform a systematic review and give an overview of the different techniques described to manage this complication intraoperatively, a systematic review was conducted in PubMed, Ovid Medline, Ovid Embase and Scopus for literature published until July 2021. Titles and abstracts were screened. Studies meeting prespecified inclusion criteria were reviewed in full. PRISMA guidelines were strictly adhered to. Out of 4492 articles, only 12 articles could be included, reflecting an underreporting of open skull base ICA injuries. Multiple techniques can be used depending on the location and size of the injury as well as the surgeon's experience. Described techniques include the following: a primary repair via a micro-suture or nonpenetrating clips; wrapping or plugging; coating; occlusion of the parent artery with or without a bypass; packing with further endovascular management. A treatment algorithm is proposed.
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Sun X, Kang F, Shen Y, Shen Y, Li J. Dexmedetomidine and Phosphocreatine Post-treatment Provides Protection against Focal Cerebral Ischemia-reperfusion Injury in Rats. Acta Histochem Cytochem 2021; 54:105-113. [PMID: 34511649 PMCID: PMC8424249 DOI: 10.1267/ahc.21-00040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 01/29/2023] Open
Abstract
In this study we investigated the neuroprotective efficacy of dexmedetomidine (Dex) and phosphocreatine (PCr) alone or in combination in a rat model of focal cerebral ischemia-reperfusion injury (I/R). I/R was induced by intraluminal middle cerebral artery occlusion (MCAO) and reperfusion. Male Sprague-Dawley rats were randomly allocated to the Sham group and I/R group, and the I/R group was further divided into three subgroups: Dex (9 μg.kg−1 Dex), PCr (180 mg.kg−1 PCr) and Dex + PCr (9 μg.kg−1 Dex + 180 mg.kg−1 PCr). All treatments were given intravenously at the onset of reperfusion. After 24 hr of reperfusion, the neurological deficit score (NDS) was determined and a magnetic resonance imaging (MRI) scan was performed. Serum concentrations of malonaldehyde (MDA) and 4-hydroxynonenal (4-HNE) were measured and cerebral infarct volume was estimated by triphenyl tetrazolium chloride (TTC) staining. Blood brain barrier, neuronal and mitochondrial damage was assessed by optical and electron microscopy. Neuronal injury was further assessed using double cleaved caspase-3 and NeuN immunofluorescent staining. Compared with group I/R, Dex and PCr significantly reduced the neurological deficit score (P < 0.01), infarct volume (P < 0.01), and brain blood barrier, neuronal and mitochondrial damage. The level of oxidative stress (P < 0.001) and neuronal injury (P < 0.001) also decreased and surviving neurons increased (P < 0.001). Compared with Dex or PCr alone, the combination treatment had overall greater effects (P < 0.05). These results indicate that posttreatment with Dex or PCr decreases focal cerebral I/R injury and that these agents in combination have greater protective effects than each alone.
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Affiliation(s)
- Xiaofen Sun
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China
| | - Fang Kang
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China
| | - Yuxian Shen
- School of Basic Medical Sciences, Anhui Medical University
| | - Yujun Shen
- School of Basic Medical Sciences, Anhui Medical University
| | - Juan Li
- Department of Anesthesiology, First Affiliated Hospital of the University of Science and Technology of China
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Lomivorotov VV, Moroz G, Abubakirov M, Osinsky R, Landoni G. Volatile and Intravenous Anesthetics for Brain Protection in Cardiac Surgery: Does the Choice of Anesthesia Matter? J Cardiothorac Vasc Anesth 2021; 36:567-576. [PMID: 33766470 DOI: 10.1053/j.jvca.2021.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/11/2022]
Abstract
Postoperative neurologic complications have a significant effect on morbidity, mortality, and long-term disability in patients undergoing cardiac surgery. The etiology of brain injury in patients undergoing cardiac surgery is multifactorial and remains unclear. There are several perioperative causative factors for neurologic complications, including microembolization, hypoperfusion, and systemic inflammatory response syndrome. Despite technologic advances and the development of new anesthetic drugs, there remains a high rate of postoperative neurologic complications. Moreover, despite the strong evidence that volatile anesthesia exerts cardioprotective effects in patients undergoing cardiac surgery, the neuroprotective effects of volatile agents remain unclear. Several studies have reported an association of using volatile anesthetics with improvement of biochemical markers of brain injury and postoperative neurocognitive function. However, there is a need for additional studies to define the optimal anesthetic drug for protecting the brain in patients undergoing cardiac surgery.
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Affiliation(s)
- Vladimir V Lomivorotov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia; Department of Anesthesiology and Intensive Care, Novosibirsk State University, Novosibirsk, Russia.
| | - Gleb Moroz
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Marat Abubakirov
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Roman Osinsky
- Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russia
| | - Giovanni Landoni
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Wu T, Sun XY, Yang X, Liu L, Tong K, Gao Y, Hao JR, Cao J, Gao C. Histone H3K9 Trimethylation Downregulates the Expression of Brain-Derived Neurotrophic Factor in the Dorsal Hippocampus and Impairs Memory Formation During Anaesthesia and Surgery. Front Mol Neurosci 2019; 12:246. [PMID: 31708739 PMCID: PMC6823536 DOI: 10.3389/fnmol.2019.00246] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/24/2019] [Indexed: 01/01/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is essential for cognitive and memory functions. Abnormal BDNF expression in the central nervous system may impair these functions. Anaesthesia and surgery can induce perioperative neurocognitive disorders (PND). Clinical studies show that BDNF expression is decreased in patients presenting with cognitive impairment after anaesthesia and surgery. However, the molecular mechanism is still unclear. Epigenetic regulation plays an important role in cognition. The hypermethylation of H3K9 is crucial for transcriptional silencing and the onset of cognitive disorders. Here, we hypothesised that H3K9 trimethylation repressed BDNF expression and impaired memory formation or recall during anaesthesia and surgery. Laparotomy under isoflurane inhalation anaesthesia, behavioural tests, Western blotting, quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR), chromatin immunoprecipitation (ChIP), and immunohistochemistry were used in this study. BDNF expression was decreased in the hippocampus after anaesthesia and surgery. Cognitive impairment affected memory formation but not recall. The trimethylation of H3K9 downregulated BDNF expression. The overexpression of BDNF or use of exogenous BDNF improved the impairment of memory formation caused by anaesthesia and surgery. Therefore, inhibiting H3K9 trimethylation and increasing the expression of BDNF may help prevent PND in the clinical setting.
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Affiliation(s)
- Tong Wu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China.,Department of Anesthesia, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xiao-Yu Sun
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Xiu Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Le Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Kun Tong
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Ya Gao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Jing-Ru Hao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
| | - Jing Cao
- Department of Anesthesia, Xuzhou Central Hospital, The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Can Gao
- Jiangsu Province Key Laboratory of Anesthesiology, Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application, Xuzhou Medical University, Xuzhou, China
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Nagasaki G, Horiguchi T, Masaki Y. Intraischemic Modest Hypothermia Does Not Prevent Onset of Locomotor Inactivity After Transient Forebrain Ischemia in Rats. Ther Hypothermia Temp Manag 2018; 9:197-203. [PMID: 30566035 DOI: 10.1089/ther.2018.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Although modest hypothermia of 35°C has been demonstrated to provide histological neuroprotection in a rodent model of cerebral ischemia, the long-term behavioral outcome is still not clear. This study was designed to investigate whether modest hypothermia of 35°C provides sustained histological and behavioral neuroprotection following transient forebrain ischemia in rats. Male Sprague-Dawley rats were randomly assigned to one of three groups: sham, control, and modest hypothermia group. Each group contained eight rats. Ten-minute transient forebrain ischemia was produced by bilateral carotid artery occlusion plus hemorrhagic hypotension (mean arterial pressure = 40 mmHg). The hypothermic group was cooled to 35°C in preischemic period, and the cooling was continued for 1 hour postischemia. To evaluate behavioral outcome, spontaneous alternation behavior and locomotor activity were assessed using Y-maze test on a weekly basis. The rats were sacrificed after 28 days, and the number of intact neurons per 1 mm in the hippocampal CA1 subfield was counted microscopically. There was significant difference between the control [19(24.5)/mm: median (interquartile range)] and hypothermia groups [116(24)/mm; p < 0.01] in the intact CA1 neuron count. In the control and modest hypothermia groups, the locomotor activities were gradually decreased, and reached significantly lower levels in comparison with the sham group at 14 days postischemia. This study indicates that intraischemic modest hypothermia provided long-term histological neuroprotection, but did not reverse the onset of locomotor inactivity in a rat transient forebrain ischemia model.
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Affiliation(s)
- Go Nagasaki
- Department of Anesthesia, Akita City Hospital, Akita, Japan
| | - Takashi Horiguchi
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoko Masaki
- Department of Anesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
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Kim JY, Shin IW, Kim S, Kang SB, Lee SH, Park KE, Lee HK, Sohn JT, Chung YK. Iatrogenic common carotid artery rupture during neck surgery rescued using covered stent - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.3.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Yoon Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Il Woo Shin
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Sunmin Kim
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Se-bin Kang
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Soo-hee Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyeong Eon Park
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Heon Keun Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Young Kyun Chung
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Jinju, Korea
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Zhang B, Wei K, Li X, Hu R, Qiu J, Zhang Y, Yao W, Zhang C, Zhu C. Upregulation of Cdh1 signaling in the hippocampus attenuates brain damage after transient global cerebral ischemia in rats. Neurochem Int 2017; 112:166-178. [PMID: 28711656 DOI: 10.1016/j.neuint.2017.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 01/27/2023]
Abstract
Cerebral ischemia is a major cause of brain dysfunction. The E3 ubiquitin ligase anaphase-promoting complex and its coactivator Cdh1 have been reported to be involved in the regulation of neuronal survival, differentiation, axonal growth and synaptic development in the central nervous system. However, its role in the ischemic brain and the underlying mechanisms remain poorly understood. The present study aimed to investigate the effects of Cdh1 overexpression on the ischemic rat brain by direct intra-hippocampal injection of lentivirus-delivered Cdh1 before transient global cerebral ischemia reperfusion. Spatial memory acquisition and retention were assessed using a Morris water maze task. Neuronal damage, glial activation, oxidative stress and the synaptic ultrastructure were also examined. The results indicated that a recombinant Cdh1-encoding lentiviral vector can upregulate the expression of Cdh1 in the rat hippocampus. Cdh1 overexpression increased the survival rates of rats, reversed the abnormal accumulation of cyclin B1, alleviated neuronal death, inhibited glial activation, mitigated oxidative stress, modulated synaptic plasticity and improved neurological deficits caused by ischemia. Our study indicates that targeting the Cdh1 signaling pathway in the hippocampus may provide a promising therapeutic strategy for the clinical treatment of transient global cerebral ischemia.
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Affiliation(s)
- Bo Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Kai Wei
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xuan Li
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Rong Hu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Jin Qiu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Yue Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Wenlong Yao
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Chuanhan Zhang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Chang Zhu
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
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11
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A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J Anesth 2017; 31:764-778. [PMID: 28585095 PMCID: PMC5640726 DOI: 10.1007/s00540-017-2375-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
A large number of studies during the past two decades have demonstrated the efficacy and safety of sevoflurane across patient populations. Clinical researchers have also investigated the effects of sevoflurane, its hemodynamic characteristics, its potential protective effects on several organ systems, and the incidence of delirium and cognitive deficiency. This review examines the clinical profiles of sevoflurane and other anesthetic agents, and focuses upon emerging topics such as organ protection, postoperative cognitive deficiency and delirium, and novel ways to improve postanesthesia outcomes.
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12
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The effect of single low-dose dexamethasone on vomiting during awake craniotomy. J Anesth 2016; 30:941-948. [DOI: 10.1007/s00540-016-2243-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
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13
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Portier K, Viguier E, Quintard B. The anaesthetic management of a lemur (
Prolemur simus
) undergoing craniotomy for brain tumour resection. VETERINARY RECORD CASE REPORTS 2016. [DOI: 10.1136/vetreccr-2016-000332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Karine Portier
- University of LyonVetAgro SupVeterinary Campus of LyonF‐69280LYONFrance
- University of LyonLaboratoire CarmenINSERM U1060INRA U1235INSA LyonUniversité Claude Bernard Lyon 1F‐69621LYONFrance
| | - Eric Viguier
- University of LyonVetAgro SupVeterinary Campus of LyonF‐69280LYONFrance
| | - Benoit Quintard
- University of LyonLaboratoire CarmenINSERM U1060INRA U1235INSA LyonUniversité Claude Bernard Lyon 1F‐69621LYONFrance
- Parc zoologique et botanique51 rue du Jardin zoologiqueF‐68100MulhouseFrance
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14
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Preischemic Administration of Sevoflurane Does not Exert Dose-dependent Effects on the Outcome of Severe Forebrain Ischemia in Rats. J Neurosurg Anesthesiol 2015; 27:216-21. [DOI: 10.1097/ana.0000000000000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Hobika G, Porhomayon J, Kocz R, Matson B, Paladino M. Prolonged Hypotension Following Innominate and Left Common Carotid Artery Bypass. J Cardiothorac Vasc Anesth 2015; 30:154-7. [PMID: 25813224 DOI: 10.1053/j.jvca.2014.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Geoffrey Hobika
- Department of Anesthesiology, VA Western New York Healthcare System, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Jahan Porhomayon
- Department of Anesthesiology, VA Western New York Healthcare System, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.
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22nd annual meeting of Chinese Society of Anesthesiology. Br J Anaesth 2014. [DOI: 10.1093/bja/aeu337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jovic M, Unic-Stojanovic D, Isenovic E, Manfredi R, Cekic O, Ilijevski N, Babic S, Radak D. Anesthetics and cerebral protection in patients undergoing carotid endarterectomy. J Cardiothorac Vasc Anesth 2014; 29:178-84. [PMID: 25287749 DOI: 10.1053/j.jvca.2014.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Miomir Jovic
- Department of Anesthesiology and Critical Care, Cardiovascular Institute "Dedinje", Belgrade, Serbia; School of Medicine, Institute Vinca, University of Belgrade, Belgrade, Serbia
| | - Dragana Unic-Stojanovic
- Department of Anesthesiology and Critical Care, Cardiovascular Institute "Dedinje", Belgrade, Serbia.
| | - Esma Isenovic
- Laboratory of Radiobiology and Molecular Genetics, Institute Vinca, University of Belgrade, Belgrade, Serbia
| | - Rizzo Manfredi
- Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Olivera Cekic
- Department of Anesthesiology and Critical Care, Cardiovascular Institute "Dedinje", Belgrade, Serbia
| | - Nenad Ilijevski
- School of Medicine, Institute Vinca, University of Belgrade, Belgrade, Serbia; Department of Vascular Surgery, Cardiovascular Institute "Dedinje", Belgrade, Serbia
| | - Srdjan Babic
- Department of Vascular Surgery, Cardiovascular Institute "Dedinje", Belgrade, Serbia
| | - Djordje Radak
- School of Medicine, Institute Vinca, University of Belgrade, Belgrade, Serbia; Department of Vascular Surgery, Cardiovascular Institute "Dedinje", Belgrade, Serbia
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Kunst G. From coronary steal to myocardial, renal, and cerebral protection: more questions than answers in anaesthetic preconditioning? Br J Anaesth 2014; 112:958-60. [PMID: 24574506 DOI: 10.1093/bja/aeu007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- G Kunst
- King's College Hospital NHS Foundation Trust, Department of Anaesthetics, Denmark Hill, London SE59RS, UK
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Jha MK, Seo M, Kim JH, Kim BG, Cho JY, Suk K. The secretome signature of reactive glial cells and its pathological implications. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2013; 1834:2418-28. [PMID: 23269363 DOI: 10.1016/j.bbapap.2012.12.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/23/2012] [Accepted: 12/12/2012] [Indexed: 12/12/2022]
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NAGASAKI G, HORIGUCHI T, NISHIKAWA T, MASAKI Y, TOBE Y. Long-term effects of post-ischaemic oestrogen on brain injury in a rat transient forebrain ischaemia model. Acta Anaesthesiol Scand 2013; 57:1245-52. [PMID: 24033295 DOI: 10.1111/aas.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND The current study was conducted to compare the effects of post-treatment with oestrogen on histological and neurological outcomes after short (7-day) and long (28-day) recovery periods in rats subjected to transient forebrain ischaemia. METHODS Male Sprague-Dawley rats were randomly assigned to one of five groups: vehicle (7-day recovery period), vehicle (28-day recovery period), oestrogen (17β-estradiol 200 μg/kg, 7-day), oestrogen (17β-estradiol 200 μg /kg, 28-day), or sham surgical (n = 8 in each group). After forebrain ischaemia was induced with bilateral carotid artery occlusion and haemorrhagic hypotension (mean arterial pressure = 40 mmHg) for 10 min, the brain was reperfused for 7 or 28 days. Either 17β-estradiol or vehicle was injected intravenously during the initial 2 min of reperfusion. To evaluate histological damage, the number of intact neurons per 1 mm in the hippocampal CA1 subfield was counted at 7 or 28 days after transient forebrain ischaemia. RESULTS At 7 days after ischaemia, the number of intact neurons in the hippocampal CA1 subfield was significantly greater in the oestrogen group [57.5 (46.5)/mm: median (interquartile range)] than in the vehicle group [10 (19.5) /mm; P = 0.014]. However, there was no difference between groups at 28 days after ischaemia [vehicle: 11 (20)/mm vs. oestrogen: 6 (11)/mm]. The neurological deficit scores in the oestrogen and vehicle groups were not different from the sham group at any point post-ischaemia. CONCLUSION The current study indicates that post-ischaemic administration of oestrogen provided short-term but not long-term neuroprotective effects in transient forebrain ischaemia in rats.
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Affiliation(s)
- G. NAGASAKI
- Department of Anesthesia and Intensive Care Medicine; Akita University Graduate School of Medicine; Akita Japan
| | - T. HORIGUCHI
- Department of Anesthesia and Intensive Care Medicine; Akita University Graduate School of Medicine; Akita Japan
| | - T. NISHIKAWA
- Department of Anesthesia and Intensive Care Medicine; Akita University Graduate School of Medicine; Akita Japan
| | - Y. MASAKI
- Department of Anesthesia and Intensive Care Medicine; Akita University Graduate School of Medicine; Akita Japan
| | - Y. TOBE
- Department of Anesthesia and Intensive Care Medicine; Akita University Graduate School of Medicine; Akita Japan
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Janata A, Drabek T, Magnet IAM, Stezoski JP, Janesko-Feldman K, Popp E, Garman RH, Tisherman SA, Kochanek PM. Extracorporeal versus conventional cardiopulmonary resuscitation after ventricular fibrillation cardiac arrest in rats: a feasibility trial. Crit Care Med 2013; 41:e211-22. [PMID: 23666097 PMCID: PMC10947746 DOI: 10.1097/ccm.0b013e318287f51e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Extracorporeal cardiopulmonary resuscitation with cardiopulmonary bypass potentially provides cerebral reperfusion, cardiovascular support, and temperature control for resuscitation from cardiac arrest. We hypothesized that extracorporeal cardiopulmonary resuscitation is feasible after ventricular fibrillation cardiac arrest in rats and improves outcome versus conventional cardiopulmonary resuscitation. DESIGN Prospective randomized study. SETTING University laboratory. SUBJECTS Adult male Sprague-Dawley rats. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Rats (intubated, instrumented with arterial and venous catheters and cardiopulmonary bypass cannulae) were randomized to conventional cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation with/without therapeutic hypothermia, or sham groups. After 6 minutes of ventricular fibrillation cardiac arrest, resuscitation was performed with drugs (epinephrine, sodium bicarbonate, and heparin), ventilation, either cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation, and defibrillation. Temperature was maintained at 37.0°C or 33.0°C for 12 hours after restoration of spontaneous circulation. Neurologic deficit scores, overall performance category, histological damage scores (viable neuron counts in CA1 hippocampus at 14 days; % of sham), and microglia proliferation and activation (Iba-1 immunohistochemistry) were assessed. RESULTS Extracorporeal cardiopulmonary resuscitation induced hypothermia more rapidly than surface cooling (p<0.05), although heart rate was lowest in the extracorporeal cardiopulmonary resuscitation hypothermia group (p<0.05). Survival, neurologic deficit scores, overall performance category, and surviving neurons in CA1 did not differ between groups. Hypothermia significantly reduced neuronal damage in subiculum and thalamus and increased the microglial response in CA1 at 14 days (all p<0.05). There was no benefit from extracorporeal cardiopulmonary resuscitation versus cardiopulmonary resuscitation on damage in any brain region and no synergistic benefit from extracorporeal cardiopulmonary resuscitation with hypothermia. CONCLUSIONS In a rat model of 6-minute ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation leads to survival with intact neurologic outcomes. Twelve hours of mild hypothermia attenuated neuronal death in subiculum and thalamus but not CA1 and, surprisingly, increased the microglial response. Resuscitation from ventricular fibrillation cardiac arrest and rigorous temperature control with extracorporeal cardiopulmonary resuscitation in a rat model is feasible, regionally neuroprotective, and alters neuroinflammation versus standard resuscitation. The use of experimental extracorporeal cardiopulmonary resuscitation should be explored using longer insult durations.
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Affiliation(s)
- Andreas Janata
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Seo J, Park H, Jeon Y, Lim Y, Nam K, Hwang J. Combined treatment with celecoxib and sevoflurane after global cerebral ischaemia has no additive neuroprotective effects in rats. Br J Anaesth 2013; 110:988-95. [DOI: 10.1093/bja/aet009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Chaparro RE, Quiroga C, Bosco G, Erasso D, Rubini A, Mangar D, Parmagnani A, Camporesi EM. Hippocampal cellular loss after brief hypotension. SPRINGERPLUS 2013; 2:23. [PMID: 23805410 PMCID: PMC3689473 DOI: 10.1186/2193-1801-2-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/23/2013] [Indexed: 01/05/2023]
Abstract
Brief episodes of hypotension have been shown to cause acute brain damage in
animal models. We used a rat hemorrhagic shock model to assess functional
outcome and to measure the relative neuronal damage at 1, 4 and 14 days
post-injury (3 min of hypotension). All rats underwent a neurological assessment
including motor abilities, sensory system evaluation and retrograde memory at
post-hypotensive insult. Brains were harvested and stained for Fluorojade C and
Nissl. Stereology was used to analyze Fluorojade C and Nissl stained brain
sections to quantitatively detect neuronal damage after the hypotensive insult.
Statistical analysis was performed using Graphpad Prism 5 with the Bonferroni
test at a 95% confidence interval after ANOVA. A Mixed Effect Model was used
for the passive avoidance evaluation. Stereologically counted fluorojade
positive cells in the hippocampus revealed significant differences in neuronal
cell injury between control rats and rats that received 3 min of hypotension one
day after insult. Quantification of Nissl positive neuronal cells showed a
significant decrease in the number hippocampal cells at day 14. No changes in
frontal cortical cells were evident at any time, no significative changes in
neurological assessments as well. Our observations show that brief periods of
hemorrhage-induced hypotension actually result in neuronal cell damage in
Sprague–Dawley rats even if the extent of neuronal damage that was
incurred was not significant enough to cause changes in motor or sensory
behavior.
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Affiliation(s)
- Rafael E Chaparro
- Department of Molecular Pharmacology and Physiology, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA ; Department of Neurosciences, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612 USA
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Abstract
PURPOSE OF REVIEW The quest for neuroprotection strategies during periods of neuronal vulnerability persists despite decades of basic and clinical research. This review will focus on the latest developments in the area of clinical brain protection with the major emphasis on strategies that can be beneficial during neurosurgical procedures. RECENT FINDINGS Brain protection in neurosurgical patients may be achieved by nonpharmacological and pharmacological strategies. Pharmacological neuroprotection including anaesthetic administration have not been recently shown to be successful. Alternatively, nonpharmacological strategies including maintenance of cerebral perfusion by adequate control of mean arterial pressure (≥80 mmHg), liberal normoglycaemia (7.8-10 mmol/l), adequate haemoglobin levels (preoperative ≥120 g/l and intraoperative ≥90 g/l) and induction of hypertension (20-40% of preoperative values) in certain neurosurgical situations can be beneficial as neuroprotectants during neurosurgery. Mild hypothermia (32-35°C) failed to achieve neuroprotective effects in several situations of brain injury. SUMMARY The findings of this review suggest that the anaesthesiologist is compelled to use nonpharmacological strategies sometimes based on empiric evidence to protect the brain during neurosurgical procedures. These strategies are simple, have high benefit/risk ratios and are inexpensive. Rigorous controlled clinical studies are needed to investigate the neuroprotective efficacy of these commonly used nonpharmacological methods.
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Sappenfield JW, Hong CM, Galvagno SM. Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project. ACTA ACUST UNITED AC 2013. [DOI: 10.7243/2049-9752-2-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Iwata M, Inoue S, Kawaguchi M, Furuya H. Effects of diazepam and flumazenil on forebrain ischaemia in a rat model of benzodiazepine tolerance. Br J Anaesth 2012; 109:935-42. [DOI: 10.1093/bja/aes340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Villa F, Iacca C, Molinari AF, Giussani C, Aletti G, Pesenti A, Citerio G. Inhalation versus endovenous sedation in subarachnoid hemorrhage patients: effects on regional cerebral blood flow. Crit Care Med 2012; 40:2797-804. [PMID: 22824929 DOI: 10.1097/ccm.0b013e31825b8bc6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Isoflurane is a volatile anesthetic that has a vasodilating effect on cerebral vessels producing a cerebral blood flow increase. Furthermore, it has been shown in animal studies that isoflurane, when used as a preconditioning agent, has neuroprotective properties, inducing tolerance to ischemia. However, it is not routinely used in neurointensive care because of the potential increase in intracranial pressure caused by the rise in cerebral blood flow. Nevertheless, subarachnoid hemorrhage patients who are at risk for vasospasm may benefit from an increase in cerebral blood flow. We measured regional cerebral blood flow during intravenous sedation with propofol and during sedation with isoflurane in patients with severe subarachnoid hemorrhage not having intracranial hypertension. DESIGN The study is a crossover, open clinical trial (NCT00830843). SETTING Neurointensive care unit of an academic hospital. PATIENTS Thirteen patients with severe subarachnoid hemorrhage, (median Fisher scale 4), monitored on clinical indication with intracranial pressure device and a thermal diffusion probe for the assessment of regional cerebral blood flow. An intracranial pressure>18 mm Hg was an exclusion criterion. INTERVENTIONS Cerebral and hemodynamic variables were assessed at three steps. Step 1: sedation with propofol 3-4 mg/kg/hr; step 2: after 1 hr of propofol discontinuation and isoflurane 0.8%; step 3: after 1 hr of propofol at the same previous infusion rate. Cerebral perfusion pressure and arterial PCO2 were maintained constant. Mean cerebral artery flow velocity and jugular vein oxygen saturation were measured at the end of each step. MEASUREMENTS AND MAIN RESULTS Regional cerebral blood flow increased significantly during step 2 (39.3±29 mL/100 hg/min) compared to step 1 (20.8±10.7) and step 3 (24.7±8). There was no difference in regional cerebral blood flow comparing step 1 vs. step 3. No significant difference in intracranial pressure, mean cerebral artery transcranial Doppler velocity, PaCO2, cerebral perfusion pressure between the different steps. CONCLUSIONS Isoflurane increases regional cerebral blood flow in comparison to propofol. Intracranial pressure did not change significantly in the population not affected by intracranial hypertension.
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Affiliation(s)
- Federico Villa
- Division of NeuroIntensive Care, Department of Anesthesia and Critical Care, Ospedale San Gerardo, Monza, Italy.
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Roehl AB, Zoremba N, Kipp M, Schiefer J, Goetzenich A, Bleilevens C, Kuehn-Velten N, Tolba R, Rossaint R, Hein M. The effects of levosimendan on brain metabolism during initial recovery from global transient ischaemia/hypoxia. BMC Neurol 2012; 12:81. [PMID: 22920500 PMCID: PMC3492141 DOI: 10.1186/1471-2377-12-81] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 08/21/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuroprotective strategies after cardiopulmonary resuscitation are currently the focus of experimental and clinical research. Levosimendan has been proposed as a promising drug candidate because of its cardioprotective properties, improved haemodynamic effects in vivo and reduced traumatic brain injury in vitro. The effects of levosimendan on brain metabolism during and after ischaemia/hypoxia are unknown. METHODS Transient cerebral ischaemia/hypoxia was induced in 30 male Wistar rats by bilateral common carotid artery clamping for 15 min and concomitant ventilation with 6% O2 during general anaesthesia with urethane. After 10 min of global ischaemia/hypoxia, the rats were treated with an i.v. bolus of 24 μg kg-1 levosimendan followed by a continuous infusion of 0.2 μg kg-1 min-1. The changes in the energy-related metabolites lactate, the lactate/pyruvate ratio, glucose and glutamate were monitored by microdialysis. In addition, the effects on global haemodynamics, cerebral perfusion and autoregulation, oedema and expression of proinflammatory genes in the neocortex were assessed. RESULTS Levosimendan reduced blood pressure during initial reperfusion (72 ± 14 vs. 109 ± 2 mmHg, p = 0.03) and delayed flow maximum by 5 minutes (p = 0.002). Whereas no effects on time course of lactate, glucose, pyruvate and glutamate concentrations in the dialysate could be observed, the lactate/pyruvate ratio during initial reperfusion (144 ± 31 vs. 77 ± 8, p = 0.017) and the glutamate release during 90 minutes of reperfusion (75 ± 19 vs. 24 ± 28 μmol·L-1) were higher in the levosimendan group. The increased expression of IL-6, IL-1ß TNFα and ICAM-1, extend of cerebral edema and cerebral autoregulation was not influenced by levosimendan. CONCLUSION Although levosimendan has neuroprotective actions in vitro and on the spinal cord in vivo and has been shown to cross the blood-brain barrier, the present results showed that levosimendan did not reduce the initial neuronal injury after transient ischaemia/hypoxia.
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Affiliation(s)
- Anna B Roehl
- Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelstrasse 30, Aachen, D-52074, Germany
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Ward DS, Karan SB, Pandit JJ. Hypoxia: developments in basic science, physiology and clinical studies. Anaesthesia 2011; 66 Suppl 2:19-26. [DOI: 10.1111/j.1365-2044.2011.06930.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
Caring in the emergency department for the patient with return of spontaneous circulation after cardiac arrest is challenging. A coordinated and systematic approach to post-cardiac arrest care can improve the mortality and the chance of meaningful neurologic recovery. By achieving appropriate targets for oxygenation, ventilation, and hemodynamic parameters, along with initiating therapeutic hypothermia and arranging early percutaneous coronary intervention, the emergency physician can have the most significant impact on patients who have just been revived from death.
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Kim SH, Kim KH, Kim JE, Yoon SZ, Ahn JH. Deep hypothermic circulatory arrest for thoracoabdominal aortic aneurysm repair in a patient with a large intracranial anterior communicating artery aneurysm. J Clin Anesth 2010; 22:546-8. [PMID: 21056812 DOI: 10.1016/j.jclinane.2009.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 06/24/2009] [Accepted: 08/21/2009] [Indexed: 10/18/2022]
Abstract
Abdominal aortic aneurysms occasionally occur concomitantly with an intracranial artery aneurysm (ICA). The association of an ICA with a thoracoabdominal aortic aneurysm (TAAA) is relatively rare. A patient with this condition is presented. Coiling of the ICA was not an option preoperatively because of the dissected false lumen of the TAAA, rendering a femoral artery approach impossible. The TAAA was repaired during deep hypothermic circulatory arrest.
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Affiliation(s)
- Seong-Hyop Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Sneyd J, Rigby-Jones A. New drugs and technologies, intravenous anaesthesia is on the move (again). Br J Anaesth 2010; 105:246-54. [DOI: 10.1093/bja/aeq190] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zitta K, Meybohm P, Bein B, Ohnesorge H, Steinfath M, Scholz J, Albrecht M. Cytoprotective effects of the volatile anesthetic sevoflurane are highly dependent on timing and duration of sevoflurane conditioning: findings from a human, in-vitro hypoxia model. Eur J Pharmacol 2010; 645:39-46. [PMID: 20655305 DOI: 10.1016/j.ejphar.2010.07.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 06/25/2010] [Accepted: 07/11/2010] [Indexed: 12/20/2022]
Abstract
Using animal models, volatile anesthetics have been recognized for their neuroprotective effects. Nevertheless, there is still disagreement about the optimal duration and timing of conditioning with the volatile anesthetic sevoflurane in the human system. In the study presented, we employed a human neuronal cell culture model to investigate the effects of hypoxia and to evaluate potential cytoprotective properties of different sevoflurane conditioning strategies. Sevoflurane was applied to human IMR-32 cells in which hypoxic conditions were induced for 2h using our recently described two-enzyme model (Zitta et al., Eur. J. Pharmacol., 2010). Cellular effects of hypoxia and sevoflurane conditioning were evaluated by lactate dehydrogenase (LDH) measurements, brightfield microscopy, ELISAs, cytometric bead arrays, Westernblotting and RT-PCR. Hypoxia increased the release of LDH into the culture medium after 24h (normoxia: 0.15+/-0.02 a.u; hypoxia: 0.69+/-0.08 a.u, P<0.001) and expression of hypoxia associated genes HIF-1alpha, VEGF, catalase. Cytoprotective effects were observed in cultures that received sevoflurane for 30 min before hypoxia (preconditioning: 0.41+/-0.07 a.u., P<0.01) and for 30 min during the hypoxic period (intraconditioning: 0.20+/-0.01 a.u., P<0.001). Application of sevoflurane after the hypoxic insult did not lead to cytoprotection (postconditioning: 0.73+/-0.12a.u., P>0.05). Conditioning with sevoflurane for a total of 3h before, during and after hypoxia, however, resulted in an enhanced release of LDH (periconditioning: 0.97+/-0.10a.u., P<0.01) and additional cell damage. Hypoxia and sevoflurane intraconditioning were associated with changes in erk1/2 phosphorylation (T202/Y204) and HIF-1alpha protein levels, whereas phosphorylation of akt (S473) was not significantly altered. Our results suggest short pre- and intraconditioning with sevoflurane as most potent strategies to reduce hypoxia induced neuronal cell damage.
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Affiliation(s)
- Karina Zitta
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Degracia DJ. Towards a dynamical network view of brain ischemia and reperfusion. Part III: therapeutic implications. ACTA ACUST UNITED AC 2010; 3:90-103. [PMID: 21278805 DOI: 10.6030/1939-067x-3.1.90] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The general failure of neuroprotectants in clinical trials of ischemic stroke points to the possibility of a fundamental blind spot in the current conception of ischemic brain injury, the "ischemic cascade". This is the third in a series of four papers whose purpose is to work towards a revision of the concept of brain ischemia by applying network concepts to develop a bistable model of brain ischemia. Here the bistable model of brain ischemia is compared to the ischemic cascade concept. The core weakness of the ischemic cascade concept is revealed to be its assumption of superposition, or that the elements of the ischemic cascade can be summed as linearly independent events. This assumption leads to a concept of neuroprotection as a subtraction of ostensibly independent damage events. The bistable model offers a different concept of neuroprotection where the role of individual molecular pathways decreases in relevance with respect to the efficacy of outcome. Network thinking provides a framework for critical assessment of widely-used preclinical experimental approaches. The importance of allometric scaling is also discussed. We illustrate that the bistable model provides a viable alternative to the ischemic cascade as an explanatory framework and as a guide for therapeutic development.
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Affiliation(s)
- Donald J Degracia
- Department of Physiology, Wayne State University, Detroit, MI 48201, U.S.A
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Oshima C, Kaneko T, Tsuruta R, Oda Y, Miyauchi T, Fujita M, Kawamura Y, Kasaoka S, Maekawa T. Increase in plasma glucagon, a factor in hyperglycemia, is related to neurological outcome in postcardiac-arrest patients. Resuscitation 2009; 81:187-92. [PMID: 20015588 DOI: 10.1016/j.resuscitation.2009.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 10/25/2009] [Accepted: 11/23/2009] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY In postcardiac-arrest (PCA) patients, hyperglycemia is a factor reflecting an unfavorable outcome, and might be caused by the inflammation and stress of "sepsis-like" syndrome. In this study, plasma glucagon, a representative glycogenolytic and gluconeogenic hormone, was measured and assessed the correlation for neurological outcome in PCA patients. METHODS This study was a retrospective, single-medical-center analysis, conducted in the intensive care unit of a university hospital. Twenty-four sequential PCA patients were included. Plasma samples were collected from the patients on days 1, 2, and 3 after the return of spontaneous circulation (ROSC). Glucagon was compared in patients with favorable and unfavorable neurological outcomes. RESULTS At all time points, plasma glucagon was significantly higher in patients with an unfavorable outcome (P<0.05). Glucagon on day 1 had remarkable sensitivity (88.2%) and specificity (85.8%) as an indicator of outcome, and correlated with the collapse-ROSC interval, the start of cardiopulmonary resuscitation (CPR)-ROSC interval, and the epinephrine dose during CPR. CONCLUSIONS Plasma glucagon reflects unfavorable outcomes in PCA patients, and might be related to ischemic and reperfusion stress.
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Affiliation(s)
- Chiyomi Oshima
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, Japan
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Anaesthetic mechanisms: update on the challenge of unravelling the mystery of anaesthesia. Eur J Anaesthesiol 2009; 26:807-20. [PMID: 19494779 DOI: 10.1097/eja.0b013e32832d6b0f] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
General anaesthesia is administered each day to thousands of patients worldwide. Although more than 160 years have passed since the first successful public demonstration of anaesthesia, a detailed understanding of the anaesthetic mechanism of action of these drugs is still lacking. An important early observation was the Meyer-Overton correlation, which associated the potency of an anaesthetic with its lipid solubility. This work focuses attention on the lipid membrane as a likely location for anaesthetic action. With the advent of cellular electrophysiology and molecular biology techniques, tools to dissect the components of the lipid membrane have led, in recent years, to the widespread acceptance of proteins, namely receptors and ion channels, as more likely targets for the anaesthetic effect. Yet these accumulated data have not produced a comprehensive explanation for how these drugs produce central nervous system depression. In this review, we follow the story of anaesthesia mechanisms research from its historical roots to the intensely neurophysiological research regarding it today. We will also describe recent findings that identify specific neuroanatomical locations mediating the actions of some anaesthetic agents.
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Cronberg T, Lilja G, Rundgren M, Friberg H, Widner H. Long-term neurological outcome after cardiac arrest and therapeutic hypothermia. Resuscitation 2009; 80:1119-23. [DOI: 10.1016/j.resuscitation.2009.06.021] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/01/2009] [Accepted: 06/10/2009] [Indexed: 11/29/2022]
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Hockey B, Leslie K, Williams D. Dexamethasone for intracranial neurosurgery and anaesthesia. J Clin Neurosci 2009; 16:1389-93. [PMID: 19665383 DOI: 10.1016/j.jocn.2009.03.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/16/2009] [Accepted: 03/11/2009] [Indexed: 11/26/2022]
Abstract
Dexamethasone is frequently administered to patients with brain tumours having neurosurgery, and is often given for other purposes by anaesthetists. This review outlines the rationale for its use by both specialities, and discusses its potential adverse effects.
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Affiliation(s)
- Brad Hockey
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Erdös G, Tzanova I, Schirmer U, Ender J. [Neuromonitoring and neuroprotection in cardiac anaesthesia. Nationwide survey conducted by the Cardiac Anaesthesia Working Group of the German Society of Anaesthesiology and Intensive Care Medicine]. Anaesthesist 2009; 58:247-58. [PMID: 19415364 DOI: 10.1007/s00101-008-1485-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary objective of this nationwide survey carried out in department of cardiac anesthesia in Germany was to identify current practice with regard to neuromonitoring und neuroprotection. METHODOLOGY The data are based on a questionnaire sent out to all departments of cardiac anesthesia in Germany between October 2007 und January 2008. The anonymized questionnaire contained 26 questions about the practice of preoperative evaluation of cerebral vessels, intra-operative use of neuromonitoring, the nature und application of cerebral protective measures, perfusion management during cardiopulmonary bypass, postoperative evaluation of neurological status, and training in the field of cerebral monitoring. RESULTS Of the 80 mailed questionnaires 55% were returned and 90% of department evaluated cerebral vessels preoperatively with duplex ultrasound. The methods used for intra-operative neuromonitoring are electroencephalography (EEG, 60%) for type A dissections (38.1%), for elective surgery on the thoracic and thoraco-abdominal aorta (34.1% and 31.6%, respectively) and in carotid surgery (43.2%) near infrared spectroscopy (40%), evoked potentials (30%) and transcranial Doppler sonography (17.5%), with some centers using combined methods. In most departments the central nervous system is not subjected to monitoring during bypass surgery, heart valve surgery, or minimally invasive surgery. Cerebral protective measures used comprise patient cooling on cardio-pulmonary bypass (CPB 100%), extracorporeal cooling of the head (65%) and the administration of corticosteroids (58%), barbiturates (50%) and antiepileptic drugs (10%). Neuroprotective anesthesia consists of administering inhalation anesthetics (32.5%; sevoflurane 76.5%) and intravenous anesthesia (20%; propofol and barbiturates each accounting for 46.2%). Of the departments 72.5% cool patients as a standard procedure for surgery involving cardiovascular arrest and 37.5% during all surgery using CPB. In 84.6% of department CPB flow equals calculated cardiac output (CO) under normothermia, while the desired mean arterial pressure (MAP) varies between 60 and 70 mmHg (43.9%) and between 50 and 60 mmHg (41.5%), respectively. At body temperatures less than 18 degrees C CPB flow is reduced below the calculated CO (70%) while 27% of departments use normothermic flow rates. The preferred MAP under hypothermia is between 50 and 60 mmHg (59%). The results of intra-operative neuromonitoring are documented on the anesthesia record (77%). In 42.5% of the departments postoperative neurological function is estimated by the anesthesiologist. Continuing education sessions pertaining to neuromonitoring are organized on a regular basis in 32.5% of the departments and in 37.5% individual physicians are responsible for their own neuromonitoring education. CONCLUSION The present survey data indicate that neuromonitoring and neuroprotective therapy during CPB is not standardized in cardiac anesthesiology departments in Germany. The systemic use of available methods to implement multimodal neuromonitoring would be desirable.
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Affiliation(s)
- G Erdös
- Inselspital, Universitätsklinik für Anästhesiologie und Schmerztherapie, Bern, Schwelz.
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Lee CH, Van Gelder C, Burns K, Cone DC. Advanced cardiac life support and defibrillation in severe hypothermic cardiac arrest. PREHOSP EMERG CARE 2009; 13:85-9. [PMID: 19145531 DOI: 10.1080/10903120802471907] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The application of Advanced Cardiac Life Support (ACLS) in severe hypothermic cardiac arrest remains controversial. While the induction of mild hypothermia has been shown to improve outcomes in patients already resuscitated from cardiac arrest, it is unknown whether ACLS protocols are effective during the resuscitation of the severely hypothermic cardiac arrest patient. We describe a case of a 47-year-old man who was successfully resuscitated from a ventricular fibrillation (VF) arrest with a core body temperature of 26.4 degrees C. The patient had been found unresponsive in a bathtub of cold water following an apparent suicide attempt. An incorrect pronouncement of death by the fire department delayed his transport to the hospital by more than four hours. Once in the emergency department (ED), the patient sustained a VF cardiac arrest and was successfully defibrillated using ACLS protocols. He ultimately survived his hospitalization with near-complete neurologic recovery. In this case report, we discuss the application of ACLS to the resuscitation of the hypothermic cardiac arrest patient as well as the issues involved in the prehospital determination of death.
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Affiliation(s)
- Christopher H Lee
- Yale-New Haven Medical Center, Emergency Medicine Residency Program, New Haven, Connecticut 06519, USA.
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Shirozu K, Akata T, Yoshino J, Setoguchi H, Morikawa K, Hoka S. The mechanisms of the direct action of etomidate on vascular reactivity in rat mesenteric resistance arteries. Anesth Analg 2009; 108:496-507. [PMID: 19151278 DOI: 10.1213/ane.0b013e3181902826] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Etomidate minimally influences hemodynamics at a standard induction dose in young healthy patients, but can cause significant systemic hypotension at higher doses for induction or electroencephalographic burst suppression (i.e., cerebral protection) in patients with advanced age or heart disease, and during cardiopulmonary bypass. However, less is known about its action on systemic resistance arteries. METHODS Using an isometric force recording method and fura-2-fluorometry, we investigated the action of etomidate on vascular reactivity in small mesenteric arteries from young (7-8 wk old, n = 179) and aged (96-98 wk old, n = 10) rats. RESULTS In the endothelium-intact strips from young rats, etomidate enhanced the contractile response to norepinephrine or KCl (40 mM) at 3 microM but inhibited it at higher concentrations (>or=10 microM). The enhancement was still observed after treatment with N(G)-nitro l-arginine, tetraethylammonium, diclofenac, nordihydroguaiaretic acid, losartan, ketanserin, BQ-123, or BQ-788, but was not observed in aged rats. In the endothelium-denuded strips from young rats, etomidate (>or=10 microM) consistently inhibited the contractile response to norepinephrine or KCl without enhancement at 3 microM. In the fura-2-loaded, endothelium-denuded strips from young rats, etomidate inhibited norepinephrine- or KCl-induced increases in both intracellular Ca(2+) concentration ([Ca(2+)]i) and force. Etomidate still inhibited the norepinephrine-induced increase in [Ca(2+)]i after depletion of the intracellular Ca(2+) stores by ryanodine, which was sensitive to nifedipine. Etomidate had little effect on norepinephrine- or caffeine-induced Ca(2+) release from the intracellular stores or Ca(2+) uptake into the intracellular stores. During stimulation with norepinephrine or KCl, etomidate had little effect on the [Ca(2+)]i-force relation at low concentrations (<or=30 microM) but caused its downward shift at 100 microM. CONCLUSIONS In small mesenteric arteries, etomidate influences the contractile response to norepinephrine or membrane depolarization through endothelium-dependent enhancing and endothelium-independent inhibitory actions. The enhancement is at least in part independent of nitric oxide, endothelium-derived hyperpolarizing factor, cyclooxygenase products, lipoxygenase products, angiotensin II, serotonin, or endothelin-1, but may involve some signaling pathway that is impaired by aging. The endothelium-independent inhibition is due to decreases in both the [Ca(2+)]i and myofilament Ca(2+) sensitivity in vascular smooth muscle cells. The decrease in [Ca(2+)]i would be due mainly to inhibition of voltage-gated Ca(2+) influx. The observed inability of lower concentrations (1-3 microM) of etomidate to cause significant vasodilation is consistent with minimal changes in hemodynamics during induction of anesthesia with etomidate in young subjects, whereas the observed vasodilator action of higher concentrations of etomidate might underlie systemic hypotension caused by higher doses of etomidate in the clinical setting.
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Affiliation(s)
- Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, Fukuoka 812-8582, Japan
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No-glucose strategy influences posterior cranial fossa tumors' postoperative course: introducing the Glycemic Stress Index. J Neurooncol 2009; 93:361-8. [DOI: 10.1007/s11060-008-9784-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 12/30/2008] [Indexed: 11/25/2022]
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Kynurenine diminishes the ischemia-induced histological and electrophysiological deficits in the rat hippocampus. Neurobiol Dis 2008; 32:302-8. [DOI: 10.1016/j.nbd.2008.07.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 06/30/2008] [Accepted: 07/25/2008] [Indexed: 11/22/2022] Open
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Elefteriades JA, Gega A, Rizzo JA. Reply. Ann Thorac Surg 2008. [DOI: 10.1016/j.athoracsur.2008.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hertz L. Bioenergetics of cerebral ischemia: a cellular perspective. Neuropharmacology 2008; 55:289-309. [PMID: 18639906 DOI: 10.1016/j.neuropharm.2008.05.023] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 05/14/2008] [Accepted: 05/14/2008] [Indexed: 12/27/2022]
Abstract
In cerebral ischemia survival of neurons, astrocytes, oligodendrocytes and endothelial cells is threatened during energy deprivation and/or following re-supply of oxygen and glucose. After a brief summary of characteristics of different cells types, emphasizing the dependence of all on oxidative metabolism, the bioenergetics of focal and global ischemia is discussed, distinguishing between events during energy deprivation and subsequent recovery attempt after re-circulation. Gray and white matter ischemia are described separately, and distinctions are made between mature and immature brains. Next comes a description of bioenergetics in individual cell types in culture during oxygen/glucose deprivation or exposure to metabolic inhibitors and following re-establishment of normal aerated conditions. Due to their expression of NMDA and non-NMDA receptors neurons and oligodendrocytes are exquisitely sensitive to excitotoxicity by glutamate, which reaches high extracellular concentrations in ischemic brain for several reasons, including failing astrocytic uptake. Excitotoxicity kills brain cells by energetic exhaustion (due to Na(+) extrusion after channel-mediated entry) combined with mitochondrial Ca(2+)-mediated injury and formation of reactive oxygen species. Many (but not all) astrocytes survive energy deprivation for extended periods, but after return to aerated conditions they are vulnerable to mitochondrial damage by cytoplasmic/mitochondrial Ca(2+) overload and to NAD(+) deficiency. Ca(2+) overload is established by reversal of Na(+)/Ca(2+) exchangers following Na(+) accumulation during Na(+)-K(+)-Cl(-) cotransporter stimulation or pH regulation, compensating for excessive acid production. NAD(+) deficiency inhibits glycolysis and eventually oxidative metabolism, secondary to poly(ADP-ribose)polymerase (PARP) activity following DNA damage. Hyperglycemia can be beneficial for neurons but increases astrocytic death due to enhanced acidosis.
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Affiliation(s)
- Leif Hertz
- College of Basic Medical Sciences, China Medical University, Shenyang, PR China.
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HOFF RG, VAN DIJK GW, METTES S, VERWEIJ BH, ALGRA A, RINKEL GJE, KALKMAN CJ. Hypotension in anaesthetized patients during aneurysm clipping: not as bad as expected? Acta Anaesthesiol Scand 2008; 52:1006-11. [DOI: 10.1111/j.1399-6576.2008.01682.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Surdell DL, Hage ZA, Eddleman CS, Gupta DK, Bendok BR, Batjer HH. Revascularization for complex intracranial aneurysms. Neurosurg Focus 2008; 24:E21. [DOI: 10.3171/foc.2008.25.2.e21] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The modern management of intracranial aneurysms includes both constructive and deconstructive strategies to eliminate the aneurysm from the circulation. Both microsurgical and endovascular techniques are used to achieve this goal. Although most aneurysms can be eliminated from the circulation with simple clip reconstruction and/or coil insertion, some require revascularization techniques to enhance tolerance of temporary arterial occlusion during clipping of the aneurysm neck or to enable proximal occlusion or trapping. In fact, the importance of revascularization techniques has grown because of the need for complex reconstructions when endovascular therapies fail. Moreover, the safety and feasibility of bypass have progressed due to advances in neuroanesthesia, technological innovations, and ~ 5 decades of accumulating wisdom by bypass practitioners. Cerebral revascularization strategies become necessary in select patients who possess challenging vascular aneurysms due to size, shape, location, intramural thrombus, atherosclerotic plaques, aneurysm type (for example, dissecting aneurysms), vessels arising from the dome, or poor collateral vascularization when parent artery or branch occlusion is required. These techniques are used to prevent cerebral ischemia and subsequent clinical sequelae. Bypass techniques should be considered in cases in which balloon test occlusion demonstrates inadequate cerebral blood flow and in which there is a need for Hunterian ligation, trapping, or prolonged temporary occlusion. This review article will focus on decision making in bypass surgery for complex aneurysms. Specifically, the authors will review graft options, the utility of balloon test occlusion in decision making, and bypass strategies for various aneurysm types.
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Affiliation(s)
| | | | | | - Dhanesh K. Gupta
- 2Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
In April 2007, there existed a repertory of 286 trials concerned with acute ischemic stroke on the Stroke Trials Registry (http://www.strokecenter.org/trials/), of which 209 trials were considered as complete (with no evidence of patient benefit unless one considers the much hard fought for and modest results of the tPA studies). Among other questions arising from such failures, one can wonder whether the plethora of pharmacological agents that exhibited neuroprotective properties in pre-clinical studies were selected for clinical trials entirely based upon their experimental efficacy. This mini-review will try to point out some of the weaknesses that could underline the failure of both researchers and clinicians involved in the field of stroke to obtain their ultimate goal--brain protection.
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Affiliation(s)
- Alan R Young
- INSERM-Avenir, tPA in the working brain, GIP CYCERON, University of Caen, Caen, France
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