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Nogi T, Uranishi K, Suzuki A, Hirasaki M, Nakamura T, Kazama T, Nagasaka H, Okuda A, Mieda T. Similarity and dissimilarity in alterations of the gene expression profile associated with inhalational anesthesia between sevoflurane and desflurane. PLoS One 2024; 19:e0298264. [PMID: 38547201 PMCID: PMC10977671 DOI: 10.1371/journal.pone.0298264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 01/22/2024] [Indexed: 04/02/2024] Open
Abstract
Although sevoflurane is one of the most commonly used inhalational anesthetic agents, the popularity of desflurane is increasing to a level similar to that of sevoflurane. Inhalational anesthesia generally activates and represses the expression of genes related to xenobiotic metabolism and immune response, respectively. However, there has been no comprehensive comparison of the effects of sevoflurane and desflurane on the expression of these genes. Thus, we used a next-generation sequencing method to compare alterations in the global gene expression profiles in the livers of rats subjected to inhalational anesthesia by sevoflurane or desflurane. Our bioinformatics analyses revealed that sevoflurane and, to a greater extent, desflurane significantly activated genes related to xenobiotic metabolism. Our analyses also revealed that both anesthetic agents, especially sevoflurane, downregulated many genes related to immune response.
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Affiliation(s)
- Takehiro Nogi
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Kousuke Uranishi
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Ayumu Suzuki
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Masataka Hirasaki
- Department of Clinical Cancer Genomics, Saitama Medical University International Medical Center, Yamane, Hidaka, Saitama, Japan
| | - Tina Nakamura
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Tomiei Kazama
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Hiroshi Nagasaka
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
| | - Akihiko Okuda
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, Yamane, Hidaka Saitama, Japan
| | - Tsutomu Mieda
- Department of Anesthesiology, Saitama Medical University Hospital, Morohongo, Moroyama, Iruma-gun, Saitama, Japan
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Meyer AJ, Smith JR, Wright TL, Engler LJ, Bigham MT, Bhalla T. Pediatric influenza vaccination in the perioperative setting: A quality improvement project. Paediatr Anaesth 2024; 34:167-174. [PMID: 37955042 DOI: 10.1111/pan.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/15/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION/BACKGROUND Unmet need for seasonal influenza vaccination administration to pediatric patients exists at national and local levels. Vaccination during the perioperative period remains controversial, though opportunity exists to meet vaccination need through perioperative programs. The initial SMART Aim of this quality improvement initiative was to establish and increase seasonal influenza vaccination rate in eligible patients during in person preoperative clinic visits in a pediatric perioperative surgical home (PSH) to 10%. Informed by each prior season's experience, we increased our SMART Aim target for vaccinations in seasons two and three to 15 and 18%, respectively. METHODS Following the Model for Improvement methodology, the PSH team developed and implemented a perioperative pediatric influenza vaccination program. Across three influenza seasons, key interventions included updates to organizational perioperative vaccination policy, obtaining material influenza vaccination supplies, development of EHR tools, PSH staff education, and communication with patient-families. Rate of eligible patients receiving influenza vaccination at their PSH clinic appointment was tracked over time. Influenza vaccination rates were reported monthly during Season 1, then weekly during seasons two and three. The balancing measure was same day surgery case cancellations related to influenza vaccination given at PSH clinic appointment. Statistical analysis methods utilized include Shewart's control chart and statistical process control (SPC) standards. Special cause variation was determined by eight or more consecutive data points above or below the centerline. RESULTS The influenza vaccination rates in each of the three influenza seasons exceeded vaccination rate goals of 10, 15, and 18%, respectively. A total of 695 vaccines have been administered since program inception. No same day surgical case cancellations were observed as balancing measure. CONCLUSIONS Over three consecutive influenza vaccination seasons, we safely established and met vaccination rate goals of 10, 15, and 18% to eligible patients during preoperative clinic visits within a pediatric PSH system. Through iterative PDSA cycles, we continue to identify opportunities for future improvement. This suggests that the perioperative period presents opportunity for seasonal influenza vaccination with potential program expansion to include routine vaccines of childhood.
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Bergmann M, Freisl M, Hartmann K. Prophylaxe der kaninen Parvovirose. TIERÄRZTLICHE PRAXIS AUSGABE K: KLEINTIERE / HEIMTIERE 2022; 50:361-369. [DOI: 10.1055/a-1945-5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ZusammenfassungObwohl Impfstoffe gegen das canine Parvovirus (CPV) weltweit eingesetzt werden, tritt die Parvovirose vor allem bei jungen Hunden nach wie vor vergleichsweise häufig auf. Der vorliegende Übersichtsartikel konzentriert sich auf die Ursachen für ein Impfversagen. Hierfür kommen unterschiedlichste Faktoren in Betracht, die den Hund selbst oder seine Umwelt betreffen. So gibt es genetisch bedingt Hunde, die keine Antikörper (Non-Responder) oder nur sehr niedrige Konzentrationen an Antikörpern (Low-Responder) nach einer CPV-Impfung ausbilden. Der Impferfolg kann auch durch andere intrinsische Faktoren (z. B. Gewicht, Alter, Reproduktions- und Ernährungsstatus, Krankheiten) und/oder extrinsische Faktoren (z. B. Stress, Belastung, Medikamente) beeinträchtigt werden. Neben Ursachen, die den individuellen Hund betreffen, kann ein Impfversagen auch durch eine reduzierte immunisierende Eigenschaft des Impfstoffs bedingt sein; hierfür kommt eine Vielzahl verschiedener Faktoren in Betracht (z. B. Herstellung, Lagerung, Applikation).
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Affiliation(s)
- Michèle Bergmann
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Monika Freisl
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Katrin Hartmann
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
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Kang Z, Zhu G, Su C, Zeng K, Li S, Wu X. Differential effects of remifentanil and sufentanil anesthesia on post-operative pain and cognitive functions. Int Immunopharmacol 2022; 108:108888. [DOI: 10.1016/j.intimp.2022.108888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/21/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023]
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Gronert BJ, Yitzhak B, Nelson JS, Bender KS. Preparation of children with heart disease for diagnostic and therapeutic procedures requiring anesthesia. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101523] [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: 10/18/2022]
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Ghodki P, Katikar M, Kulkarni P. Dog bite and antirabies vaccination: What the anaesthesiologist needs to know. Indian J Anaesth 2021; 65:632-633. [PMID: 34584291 PMCID: PMC8445222 DOI: 10.4103/ija.ija_113_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/29/2021] [Accepted: 05/07/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Poonam Ghodki
- Department of Anaesthesia, Srimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
| | - Manisha Katikar
- Department of Anaesthesia, Srimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
| | - Priyanka Kulkarni
- Department of Anaesthesia, Srimati Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra, India
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Lin C, Vazquez-Colon C, Geng-Ramos G, Challa C. Implications of anesthesia and vaccination. Paediatr Anaesth 2021; 31:531-538. [PMID: 33540468 DOI: 10.1111/pan.14148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
The current COVID-19 pandemic has had a global impact on vaccination rates. Delays in routine healthcare and immunization have led to a rise in concerns about resurgence of vaccine-preventable diseases around the world. With the release and distribution of COVID-19 vaccines, plans to improve immunization rates need to be explored and implemented across disciplines. One approach would be the consideration of perioperative vaccinations; however, the effects of anesthesia and surgery on the immune response and complications associated with vaccination during the perioperative period are still poorly understood, and opinions are divided. To ascertain the value of a perioperative vaccination program, it is important to understand the basics of immunization and common vaccinations; the potential vaccine complications in the pediatric cohort; the implications of anesthesia and surgery on the immune response; and current recommendations. In addition, we believe it is important to discuss the logistics and feasibility of coordinating perioperative immunization should this become a regular opportunity.
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Affiliation(s)
- Connie Lin
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
| | - Caroll Vazquez-Colon
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
| | - Giuliana Geng-Ramos
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
| | - Chaitanya Challa
- Department of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, Washington, DC, USA
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Limper U, Defosse J, Schildgen O, Wappler F. Perioperative risk evaluation in patients scheduled for elective surgery in close relation to their SARS-CoV-2 vaccination. Br J Anaesth 2021; 126:e225-e226. [PMID: 33863474 PMCID: PMC7980143 DOI: 10.1016/j.bja.2021.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ulrich Limper
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany.
| | - Jerome Defosse
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
| | - Oliver Schildgen
- Institute of Pathology, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
| | - Frank Wappler
- Department of Anesthesiology and Critical Care Medicine, Merheim Medical Center, Hospitals of Cologne, Witten/Herdecke University, Cologne, Germany
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Becke-Jakob K, Eich C, Röher K. Präoperative Vorbereitung in der Kinderanästhesie. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-01040-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Casciani F, Trudeau MT, Vollmer CM. Perioperative Immunization for Splenectomy and the Surgeon's Responsibility: A Review. JAMA Surg 2020; 155:1068-1077. [PMID: 32936229 DOI: 10.1001/jamasurg.2020.1463] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Patients who have had splenectomy have a lifelong risk of overwhelming postsplenectomy infection (OPSI), a condition associated with high mortality rates. Surgeons must be aware of the rationale of vaccination in the case of splenectomy, to provide appropriate immunization in the perioperative time. Observations English-language articles published from January 1, 1990, to December 31, 2019, were retrieved from MEDLINE/PubMed, Cochrane Library, and ClinicalTrials.gov databases. Randomized clinical trials as well as systematic reviews and observational studies were considered. Asplenia yields an impairment of both innate and adaptive immunity, thus increasing the risk of severe encapsulated bacterial infections. Current epidemiology of OPSI ranges from 0.1% to 8.5% but is hard to ascertain because of ongoing shifts in patients' baseline conditions and vaccine penetration. Despite the lack of randomized clinical trials, immunization appears to be effective in reducing OPSI incidence. Unfortunately, vaccination coverage is still suboptimal, with a great variability in vaccination rates being reported across institutions and time frames. Notably, current guidelines do not advocate any particular health care qualification responsible for vaccine prescription or administration. Given the dearth of high-level basic science or clinical evidence, the optimal vaccination timing and the need for booster doses are not yet well established. Although almost all guidelines indicate to not administer vaccines within 14 days before and after surgery, most data suggest that immunization might be effective even in the immediate perioperative time, thus placing the surgeon in a primary position for vaccine delivery. Furthermore, revaccination schedules are the target of ongoing debates, since a vaccine-driven hyporesponsiveness has been postulated. Conclusions and Relevance In patients who have undergone splenectomy, OPSI might be effectively prevented by proper immunization. Surgeons have the primary responsibility for achieving adequate, initial immunization in the setting of both planned and urgent splenectomy.
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Affiliation(s)
- Fabio Casciani
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Maxwell T Trudeau
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
| | - Charles M Vollmer
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia
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Zhao J, Kang Z, Xie W, Lin H, Liu Y. Effects of Depth of Anesthesia Monitored by IoC on Patients Undergoing Laparoscopic Radical Resection of Colorectal Cancer. Mol Ther Methods Clin Dev 2020; 18:304-311. [PMID: 32637458 PMCID: PMC7330423 DOI: 10.1016/j.omtm.2020.05.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
Index of consciousness (IoC) consisting of IoC1 and IoC2, is a new analgesia monitoring indicator in anesthesia evaluation in the laparoscopic radical resection of colorectal cancer. Although the precise anesthetic dosage adjusted by IoC1 has been confirmed to enhance the recovery and reduce the complications of anesthesia, the most appropriate range of IoC2 during anesthesia remains unclear. To investigate the correlation between IoC2 and peri-operative indicators of patients during laparoscopic radical resection of colorectal cancer, the current randomized, controlled, and single-blinded clinical trial was performed. Participants were divided randomly into three groups with different anesthesia depth monitored by IoC2 during their laparoscopic radical resections. Primary outcomes included the dosage of remifentanil. Secondary outcomes included other physiological indexes and complications. The remifentanil dosage and the awakening time increased as IoC2 decreased. The incidences of hypotension and hypoxemia decreased with the elevated IoC2, but the risk of intra-operative awareness also increased. The impact caused by anesthesia to the immune system and health-related life quality of the patients descended with reduced anesthetic level. The IoC2 range of 35–45 could represent the most appropriate anesthetic depth during laparoscopic radical resection, which provides a new perspective for the clinical treatment of colon cancer.
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Lee HG, Bae HB, Choi JI, Pyeon T, Kim S, Kim J. Febrile convulsions during recovery after anesthesia in an infant with history of MMR vaccination: A case report. Medicine (Baltimore) 2019; 98:e17047. [PMID: 31464964 PMCID: PMC6736039 DOI: 10.1097/md.0000000000017047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Seizures are rare during the perioperative period; in most cases, there is a previous history of epilepsy or surgery-associated seizures. Febrile convulsions may occur when the body temperature rises above 38°C; this is the most common cause of seizures in children. Febrile convulsions after general anesthesia in the postanesthetic care unit (PACU) without a past or family history are rare. Some reviews suggest that since anesthesia changes immunity, elective surgery should be postponed three weeks after live vaccination. PATIENT A 12-month-old female with bilateral hearing loss underwent cochlear implantation under general anesthesia. She did not have any history of convulsions or developmental disorders. However, 1 week before surgery, measles-mumps-rubella (MMR) vaccination was given as a regular immunization. DIAGNOSES Forty minutes after arrival at the PACU, sudden generalized tonic-clonic movement occurred during recovery and the patient's measured body temperature exceeded 38.0°C. INTERVENTIONS Thiopental sodium was administered intravenously as an anticonvulsant, and the tonic-clonic movement stopped immediately. Endotracheal intubation was performed to secure the airway, and tepid massage and diclofenac β-dimethylaminoethanol administration were performed to lower the patient's body temperature. OUTCOMES There was no further fever and no seizures, and no other neurological deficits were observed until discharge. LESSONS The anesthesiologist should check the recent vaccination history even if the patient has not developed particular symptoms after vaccination. It is important to know that febrile convulsions may occur in patients who have recently received MMR vaccination.
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