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Müller-Edenborn B, Frick R, Piegeler T, Schläpfer M, Roth-Z'graggen B, Schlicker A, Beck-Schimmer B. Volatile anaesthetics reduce neutrophil inflammatory response by interfering with CXC receptor-2 signalling. Br J Anaesth 2014; 114:143-9. [PMID: 24989774 DOI: 10.1093/bja/aeu189] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growing evidence suggests a protective effect of volatile anaesthetics in ischaemia-reperfusion (I/R)-injury, and the accumulation of neutrophils is a crucial event. Pro-inflammatory cytokines carrying the C-X-C-motif including interleukin-8 (IL-8) and CXC-ligand 1 (CXCL1) activate CXC receptor-1 (CXCR1; stimulated by IL-8), CXC receptor-2 (CXCR2; stimulated by IL-8 and CXCL1), or both to induce CD11b-dependent neutrophil transmigration. Inhibition of CXCR1, CXCR2, or both reduces I/R-injury by preventing neutrophil accumulation. We hypothesized that interference with CXCR1/CXCR2 signalling contributes to the well-established beneficial effect of volatile anaesthetics in I/R-injury. METHODS Isolated human neutrophils were stimulated with IL-8 or CXCL1 and exposed to volatile anaesthetics (sevoflurane/desflurane). Neutrophil migration was assessed using an adapted Boyden chamber. Expression of CD11b, CXCR1, and CXCR2 was measured by flow cytometry. Blocking antibodies against CXCR1/CXCR2/CD11b and phorbol myristate acetate were used to investigate specific pathways. RESULTS Volatile anaesthetics reduced CD11b-dependent neutrophil transmigration induced by IL-8 by >30% and CD11b expression by 18 and 27% with sevoflurane/desflurane, respectively. This effect was independent of CXCR1/CXCR2 expression and CXCR1/CXCR2 endocytosis. Inhibition of CXCR1 signalling did not affect downregulation of CD11b with volatile anaesthetics. Blocking of CXCR2-signalling neutralized effects by volatile anaesthetics on CD11b expression. Specific stimulation of CXCR2 with CXCL1 was sufficient to induce upregulation of CD11b, which was impaired with volatile anaesthetics. No effect of volatile anaesthetics was observed with direct stimulation of protein kinase C located downstream of CXCR1/CXCR2. CONCLUSION Volatile anaesthetics attenuate neutrophil inflammatory responses elicited by CXC cytokines through interference with CXCR2 signalling. This might contribute to the beneficial effect of volatile anaesthetics in I/R-injury.
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Affiliation(s)
- B Müller-Edenborn
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland
| | - R Frick
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland
| | - T Piegeler
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland Department of Anesthesiology, University of Illinois Hospital & Health Sciences Center, Chicago, IL, USA
| | - M Schläpfer
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland
| | - B Roth-Z'graggen
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland
| | - A Schlicker
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland
| | - B Beck-Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, Zürich, Switzerland Institute of Physiology, Zurich Center of Integrative Human Physiology, University of Zurich, Zürich, Switzerland
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Harr JN, Moore EE, Stringham J, Wohlauer MV, Fragoso M, Jones WL, Gamboni F, Silliman CC, Banerjee A. Isoflurane prevents acute lung injury through ADP-mediated platelet inhibition. Surgery 2012; 152:270-6. [PMID: 22828148 PMCID: PMC3419262 DOI: 10.1016/j.surg.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 05/10/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing evidence suggests platelets are essential in posttraumatic, acute lung injury (ALI). Halogenated ethers interfere with the formation of platelet-granulocyte aggregates. The potential benefit of halogenated ethers has not been investigated in models of trauma/hemorrhagic shock (T/HS). Therefore, we hypothesized that isoflurane decreases T/HS-mediated ALI through platelet inhibition. METHODS Sprague-Dawley rats (n = 47) were anesthetized by either pentobarbital or inhaled isoflurane and placed into (1) control, (2) trauma (laparotomy) sham shock, (3) T/HS (mean arterial pressure, 30 mmHg × 45 min), (4) pretreatment with an ADP receptor antagonist, or (5) T/HS with isoflurane initiated during resuscitation groups. ALI was determined by protein and pulmonary immunofluorescence bronchoalveolar lavage (BAL) fluid. Platelet Mapping specifically evaluated thrombin-independent inhibition of the ADP and AA pathways of platelet activation. RESULTS Pretreatment with isoflurane abrogated ALI as measured by both BAL fluid protein and pulmonary immunofluorescence (P < .001). Platelet Mapping revealed specific inhibition of the platelet ADP-pathway with isoflurane (P < .001). Pretreatment with an ADP receptor antagonist decreased ALI to sham levels, confirming that specific platelet ADP inhibition decreases ALI. Isoflurane initiated during resuscitation also decreased ALI (P < .001). CONCLUSION Isoflurane attenuates ALI through an antiplatelet mechanism, in part, through inhibition of the platelet ADP pathway. Isoflurane given postinjury also protects against ALI, and highlights the potential applications of this therapy in various clinical scenarios of ischemia/reperfusion.
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Affiliation(s)
- Jeffrey N. Harr
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Ernest E. Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - John Stringham
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Max V. Wohlauer
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Miguel Fragoso
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | | | - Fabia Gamboni
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Christopher C. Silliman
- Trauma Research Center, University of Colorado Denver, Aurora, CO
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
- Research Department, Bonfils Blood Center, Denver, CO
| | - Anirban Banerjee
- Trauma Research Center, University of Colorado Denver, Aurora, CO
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Cardinale F, Mastrototaro MF, Cappiello A, Caffarelli C, Caimmi S, Barberi S, Bernardini R. Immunological modifications induced from products used during the perioperative period. Int J Immunopathol Pharmacol 2012; 24:S13-20. [PMID: 22014921 DOI: 10.1177/03946320110240s303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anesthetics and other products used during the perioperative period may influence immune function not only merely by reducing the HPA-axis stress response but also by directly modulating innate and adaptive immune responses. Most of the literature on the immune effects of anesthetics has been derived from in vitro or animal studies, due to the number of confounding variables in real life surgical settings. These immunosuppressive effects might not normally have clinical consequences for an immune-competent patient, but may act as important modifiers in postoperative morbidity and mortality. Furthermore, some inhibitory effects on neutrophil functions may provide a therapeutically beneficial effect under specific surgical clinical conditions, such as ischemia-reperfusion injury.
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Affiliation(s)
- F Cardinale
- Department of Allergy and Pulmonology, Pediatric Hospital Giovanni XXIII, University of Bari, Bari, Italy.
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Saad MM, Eom W, Hu G, Kim SJ, Crystal GJ. Persistency and pathway of isoflurane-induced inhibition of superoxide production by neutrophils. Can J Anaesth 2009; 57:50-7. [PMID: 19882198 DOI: 10.1007/s12630-009-9205-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Accepted: 10/01/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our previous work has demonstrated that treatment with isoflurane has a preconditioning-like inhibitory effect on superoxide production (SOP) by polymorphonuclear neutrophils. The current objectives were to determine persistency of this effect and to clarify where in the signalling pathway this inhibition of SOP occurred. The latter was accomplished using two receptor-dependent neutrophil agonists, platelet activating factor (PAF) and formyl-methionyl-leucyl-phenylalanine (fMLP), and two receptor-independent neutrophil stimuli, the protein-kinase C stimulator, phorbol myristate acetate (PMA), and the calcium ionophore, A23187. METHODS Arterial blood samples were obtained from eight dogs under baseline condition (conscious state), during isoflurane (1 MAC) administration, and 24 and 48 hr post-isoflurane (also in conscious state). Neutrophils were isolated and stimulated with 1 muM concentrations of PAF, fMLP, PMA, and A23187. SOP was measured spectrophotometrically. RESULTS Isoflurane administration caused (1) an approximate 50% decrease in SOP during PAF or fMLP (P < 0.01 vs baseline), which remained evident from 24 to 48 hr following isoflurane; (2) an initial 29% decrease in SOP during PMA (P < 0.05 vs baseline), which returned to baseline by 24 hr following isoflurane; and (3) no change in SOP during A23187 (P > 0.05 vs baseline). CONCLUSIONS Isoflurane administration caused prolonged (from 24 to 48 hr) decreases in agonist-induced SOP by neutrophils. This effect involved inhibition at site(s) in the signalling pathway upstream from protein kinase C. The current findings suggest that the intraoperative use of isoflurane may result in an extended impairment to the antibacterial host defense mechanism and that neutrophil inhibition may play a role in the delayed tissue protection afforded by treatment with volatile anesthetics.
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Affiliation(s)
- Maged M Saad
- Section of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Ion channel modulators mediated alterations in NO-induced free radical generation and neutrophil membrane potential. Free Radic Res 2009; 43:514-21. [DOI: 10.1080/10715760902887276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kurosawa S, Kato M. Anesthetics, immune cells, and immune responses. J Anesth 2008; 22:263-77. [PMID: 18685933 DOI: 10.1007/s00540-008-0626-2] [Citation(s) in RCA: 222] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Accepted: 03/13/2008] [Indexed: 12/13/2022]
Abstract
General anesthesia accompanied by surgical stress is considered to suppress immunity, presumably by directly affecting the immune system or activating the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Along with stress such as surgery, blood transfusion, hypothermia, hyperglycemia, and postoperative pain, anesthetics per se are associated with suppressed immunity during perioperative periods because every anesthetic has direct suppressive effects on cellular and neurohumoral immunity through influencing the functions of immunocompetent cells and inflammatory mediator gene expression and secretion. Particularly in cancer patients, immunosuppression attributable to anesthetics, such as the dysfunction of natural killer cells and lymphocytes, may accelerate the growth and metastases of residual malignant cells, thereby worsening prognoses. Alternatively, the anti-inflammatory effects of anesthetics may be beneficial in distinct situations involving ischemia and reperfusion injury or the systemic inflammatory response syndrome (SIRS). Clinical anesthesiologists should select anesthetics and choose anesthetic methods with careful consideration of the clinical situation and the immune status of critically ill patients, in regard to long-term mortality, morbidity, and the optimal prognosis.
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Affiliation(s)
- Shin Kurosawa
- Department of Anesthesiology and Intensive Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Symons JA, Myles PS. Myocardial protection with volatile anaesthetic agents during coronary artery bypass surgery: a meta-analysis. Br J Anaesth 2006; 97:127-36. [PMID: 16793778 DOI: 10.1093/bja/ael149] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Previous studies have investigated the role of volatile anaesthetic agents in myocardial protection during coronary artery bypass graft (CABG) surgery, and some have identified beneficial effects. However, these studies have been too small to identify a significant effect on myocardial infarction (MI) or mortality. We undertook a systematic overview and meta-analysis of all randomized trials comparing volatile with non-volatile anaesthesia in CABG surgery. We identified 27 trials that included 2979 patients. There was no significant difference in myocardial ischaemia, MI, intensive care unit length of stay or hospital mortality between the groups (all P>0.05). Post-bypass, patients randomized to receive volatile anaesthetics had 20% higher cardiac indices (P=0.006), significantly lower troponin I serum concentrations (P=0.002) and lesser requirement for inotropic support (P=0.004) compared with those randomized to receive i.v. anaesthetics. Duration of mechanical ventilation was reduced by 2.7 h (P=0.04), and there was a 1 day decrease in hospital length of stay (P<0.001). Some of these outcomes were based on a smaller number of trials because of incomplete data, largely because the individual trials focused on one or more surrogate endpoints. We found some evidence that volatile anaesthetic agents provide myocardial protection in CABG surgery, but larger adequately powered trials with agreed, defined outcomes need to be done to fully assess a possible beneficial effect of volatile anaesthetic agents on the risk of MI and mortality.
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Affiliation(s)
- J A Symons
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
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Kim JU, Lee HJ, Kang HH, Shin JW, Ku SW, Ahn JH, Kim YJ, Chung JW. Protective Effect of Isoflurane Anesthesia on Noise-Induced Hearing Loss in Mice. Laryngoscope 2005; 115:1996-9. [PMID: 16319612 DOI: 10.1097/01.mlg.0000180173.81034.4d] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
HYPOTHESIS/OBJECTIVES To examine the protective effect of general anesthesia with isoflurane against noise-induced hearing loss in mice. STUDY DESIGN Animal study using noise stimulation and measurement of hearing in BALB/c mice. METHODS Mice were exposed to 122 dB peak equivalent sound pressure level click noise for 3 hours per day for 3 consecutive days with or without anesthesia using isoflurane. Hearing levels were measured and hair cell survival ratio was observed. RESULTS In mice without anesthesia, hearing threshold increased after noise stimulation (73.7 dB hearing level [HL]) and persisted for at least 1 month. However, in mice exposed to noise under anesthesia, hearing loss was less severe (44.1 dB HL) and had recovered more (26.5 dB HL) by one month. Histological examination showed hair cell survival was higher in anesthetized compared to non-anesthetized mice. CONCLUSION These data indicate isoflurane general anesthesia protects against noise-induced hearing loss and tissue damage in mice.
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MESH Headings
- Anesthesia, Inhalation
- Anesthetics, Inhalation/therapeutic use
- Animals
- Cell Survival/drug effects
- Disease Models, Animal
- Evoked Potentials, Auditory/drug effects
- Evoked Potentials, Auditory/physiology
- Follow-Up Studies
- Hair Cells, Auditory/pathology
- Hearing Loss, Noise-Induced/pathology
- Hearing Loss, Noise-Induced/physiopathology
- Hearing Loss, Noise-Induced/prevention & control
- Isoflurane/therapeutic use
- Mice
- Mice, Inbred BALB C
- Severity of Illness Index
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Affiliation(s)
- Joung Uk Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Hu G, Salem MR, Crystal GJ. Isoflurane Prevents Platelets from Enhancing Neutrophil-Induced Coronary Endothelial Dysfunction. Anesth Analg 2005; 101:1261-1268. [PMID: 16243978 DOI: 10.1213/01.ane.0000181340.28271.4f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated whether platelets can enhance polymorphonuclear neutrophil-induced coronary endothelial dysfunction, and, after observing this, whether isoflurane can prevent the effect. Neutrophils, coronary artery segments, and platelets were obtained from 25 healthy dogs. Coronary artery rings were exposed to neutrophils activated with platelet-activating factor (1.0 microM), and after washing and preconstriction with U46619, were evaluated for concentration-related responses to acetylcholine, an endothelium-dependent vasorelaxing drug. Superoxide production by activated neutrophils was measured spectrophotometrically. Adherence of the activated neutrophils to the endothelium of coronary segments was assessed by direct counting of neutrophils labeled with fluorescent dye. Measurements were performed in absence and presence of isoflurane (1 minimum alveolar concentration) both with and without platelets. The presence of platelets enhanced the neutrophil-induced rightward shift in the concentration-vasorelaxation response curve to acetylcholine (the concentration of acetylcholine required to elicit 50% of maximal relaxation (-log M) was increased from 6.78 +/- 0.7 to 5.26 +/- 0.6), and it increased superoxide oxide production from 45.0 +/- 4.2 to 54.3 +/- 4.2 nM O2-/5 x 10(6) neutrophils and adherence of activated neutrophils from 204 +/- 10 to 268 +/- 5 neutrophils/mm2. Isoflurane abolished these effects of platelets. In conclusion, platelets enhanced the ability of neutrophils to cause coronary endothelial dysfunction. This effect was prevented by isoflurane. This may be attributable to an inhibitory action on superoxide production by the neutrophils leading to reduced expression of endothelial adhesion molecules and, in turn, reduced neutrophil adherence.
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Affiliation(s)
- Guochang Hu
- *Department of Anesthesiology, Advocate Illinois Masonic Medical Center, and Department of Anesthesiology, University of Illinois College of Medicine; †Department of Physiology and Biophysics, University of Illinois College of Medicine, Chicago, Illinois
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Gozal Y, Raphael J, Rivo J, Berenshtein E, Chevion M, Drenger B. Isoflurane does not mimic ischaemic preconditioning in decreasing hydroxyl radical production in the rabbit. Br J Anaesth 2005; 95:442-7. [PMID: 16040636 DOI: 10.1093/bja/aei203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Reactive oxygen species are an important mediator in isoflurane-induced myocardial preconditioning. However, hydroxyl radicals are also released during reperfusion after regional ischaemia. The purpose of the present study was to test whether ischaemic preconditioning and isoflurane would influence the production of hydroxyl radicals during reperfusion. METHODS After i.v. administration of salicylate 100 mg kg(-1) and a 30 min stabilization period, New Zealand White rabbits were subjected to 40 min of regional myocardial ischaemia and 2 h of reperfusion. Ischaemic preconditioning was elicited by 5 min ischaemia followed by 10 min reperfusion (before the 40 min ischaemia). In another group, isoflurane (2.1%) was administered for 30 min, followed by 15 min washout, before the long ischaemia. Area at risk and infarct size were assessed by blue dye injection and tetrazolium chloride staining. We quantified the level of OH-mediated conversion of salicylate to its dihydrobenzoate derivatives (2,3- and 2,5-DHBAs). Normalized values of the DHBAs (ng DHBA per mg salicylate) were calculated. RESULTS Mean (se) infarct size was 57 (6)% of the risk area in the untreated controls. This was significantly smaller in the ischaemic preconditioning and isoflurane groups: 22 (5) and 23 (6)% respectively. At 10 min of reperfusion, ischaemic preconditioning limited the mean increase in 2,3-DHBA to 24% from baseline, compared with 81% in control and 74% in the isoflurane group. Normalized 2,5-DHBA was maximally increased by 75% in the untreated group, 4 min after reperfusion. Ischaemic preconditioning significantly inhibited this increase (24% increase from baseline, P<0.01). However, the increase observed in the isoflurane group was not different from control (71%). CONCLUSIONS As already known, ischaemic preconditioning and isoflurane markedly reduced infarct size. However, only ischaemic preconditioning decreased postischaemic production of hydroxyl radicals. These different effects suggest different protective mechanisms at the cellular level.
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Affiliation(s)
- Y Gozal
- Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Suliburk JW, Gonzalez EA, Kennison SD, Helmer KS, Mercer DW. Differential effects of anesthetics on endotoxin-induced liver injury. ACTA ACUST UNITED AC 2005; 58:711-6; discussion 716-7. [PMID: 15824646 DOI: 10.1097/01.ta.0000159245.60495.00] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The liver is both a source and a target of inflammatory and anti-inflammatory mediators during sepsis. The oxidative stress proteins inducible nitric oxide synthase (iNOS) and heme oxygenase-1 (HO-1) are upregulated in the liver during sepsis but have opposite roles. Upregulation of HO-1 has hepatoprotective effects, whereas iNOS has injurious effects to the liver. Although recent studies indicate that ketamine anesthesia has anti-inflammatory effects during sepsis, the effects of other anesthetics are unknown. We hypothesized that ketamine, but not isoflurane, would attenuate lipopolysaccharide (LPS)-induced liver injury through differential modulation of iNOS and HO-1. METHODS Adult rats were given no anesthesia (saline), continuous isoflurane inhalation, or intraperitoneal ketamine (70 mg/kg). One hour later, saline or LPS (20 mg/kg intraperitoneally) was given for 5 hours. Rats were killed, serum prepared for determination of hepatocellular enzymes, and the liver assessed for iNOS and HO-1 by Western immunoblot. RESULTS LPS significantly increased serum aspartate aminotransferase levels, iNOS, and HO-1 immunoreactivity in the liver. Ketamine but not isoflurane attenuated LPS-induced liver injury, upregulated HO-1, and downregulated iNOS. CONCLUSION These data indicate that anesthetics differ in their effects on the liver in a rat model of sepsis with LPS. Ketamine has hepatoprotective effects against LPS-induced liver injury that appear to be mediated, at least in part, by differential modulation of the oxidative stress proteins iNOS and HO-1. Thus, ketamine may be the anesthetic agent of choice for septic patients requiring anesthesia.
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Affiliation(s)
- James W Suliburk
- Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas, USA
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Volatile Anesthetic-Induced Inhibition of Superoxide Production by Neutrophils Exhibits an Acute Memory Phase. Anesthesiology 2002. [DOI: 10.1097/00000542-200209002-00670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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