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Zhang Y, Li J, Li Y, Wang W, Wang D, Ding J, Wang L, Cheng J. Dexmedetomidine Promotes NREM Sleep by Depressing Oxytocin Neurons in the Paraventricular Nucleus in Mice. Neurochem Res 2024; 49:2926-2939. [PMID: 39078522 DOI: 10.1007/s11064-024-04221-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
Dexmedetomidine (DEX) is a highly selective α2-adrenoceptor agonist with sedative effects on sleep homeostasis. Oxytocin-expressing (OXT) neurons in the paraventricular nucleus (PVN) of the hypothalamus (PVNOXT) regulate sexual reproduction, drinking, sleep-wakefulness, and other instinctive behaviors. To investigate the effect of DEX on the activity and signal transmission of PVNOXT in regulating the sleep-wakefulness cycle. Here, we employed OXT-cre mice to selectively target and express the designer receptors exclusively activated by designer drugs (DREADD)-based chemogenetic tool hM3D(Gq) in PVNOXT neurons. Combining chemogenetic methods with electroencephalogram (EEG) /electromyogram (EMG) recordings, we found that cannula injection of DEX in PVN significantly increased the duration of non-rapid eye movement (NREM) sleep in mice. Furthermore, the chemogenetic activation of PVNOXT neurons using i.p. injection of clozapine N-oxide (CNO) after cannula injection of DEX to PVN led to a substantial increase in wakefulness. Electrophysiological results showed that DEX decreased the frequency of action potential (AP) and the spontaneous excitatory postsynaptic current (sEPSC) of PVNOXT neurons through α2-adrenoceptors. Therefore, these results identify that DEX promotes sleep and maintains sleep homeostasis by inhibiting PVNOXT neurons through the α2-adrenoceptor.
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Affiliation(s)
- Ying Zhang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jiaxin Li
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yan Li
- Department of Pharmacy, Linquan People's Hospital, Linquan, 236400, Anhui, China
| | - Wei Wang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Daming Wang
- Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Junli Ding
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Licheng Wang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China.
- College of Stomatology, Anhui Medical University, Hefei, 230032, Anhui, China.
| | - Juan Cheng
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, Anhui, China.
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Jiang L, Xiong W, Yang Y, Qian J. Insight into Cardioprotective Effects and Mechanisms of Dexmedetomidine. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07579-9. [PMID: 38869744 DOI: 10.1007/s10557-024-07579-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE Cardiovascular disease remains the leading cause of death worldwide. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist with sedative, analgesic, anxiolytic, and sympatholytic properties, and several studies have shown its possible protective effects in cardiac injury. The aim of this review is to further elucidate the underlying cardioprotective mechanisms of dexmedetomidine, thus suggesting its potential in the clinical management of cardiac injury. RESULTS AND CONCLUSION Our review summarizes the findings related to the involvement of dexmedetomidine in cardiac injury and discusses the results in the light of different mechanisms. We found that numerous mechanisms may contribute to the cardioprotective effects of dexmedetomidine, including the regulation of programmed cell death, autophagy and fibrosis, alleviation of inflammatory response, endothelial dysfunction and microcirculatory derangements, improvement of mitochondrial dysregulation, hemodynamics, and arrhythmias. Dexmedetomidine may play a promising and beneficial role in the treatment of cardiovascular disease.
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Affiliation(s)
- Leyu Jiang
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Xiong
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuqiao Yang
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinqiao Qian
- Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Alseoudy MM, Abdelkarime EM, Nour K, Badr ME. The value of local dexmedetomidine as an adjuvant to ultrasound-guided wide awake local anesthesia no tourniquet (WALANT) in flexor tendon repair surgeries: a randomized controlled trial. BMC Anesthesiol 2024; 24:120. [PMID: 38539076 PMCID: PMC10967158 DOI: 10.1186/s12871-024-02504-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique allows intraoperative motor assessment of tendon repair integrity of the hand compared with general anesthesia or brachial plexus block. No studies have tested the effect of adding dexmedetomidine to lidocaine on the analgesic properties of the WALANT technique, which is the aim of our study. METHODS A total of 128 patients aged more than 18 years were scheduled for surgical flexor tendon injury repair using WALANT technique. Patients were divided into two equal groups. Ultrasound-guided subcutaneous injection of lidocaine 1% with dexmedetomidine (1 µg/kg), Group D, or without dexmedetomidine, Group C, was performed at four points: proximal to the wrist joint, the distal forearm, palm region, and proximal phalanges. The primary outcome was total morphine consumption throughout the first postoperative day. Secondary outcomes included number of patients requiring rescue analgesia, time to first analgesic request, and pain score. RESULTS Total morphine consumption was significantly (P < 0.001) lower in group D (2.66 ± 0.998) than in group C (3.66 ± 1.144) mg. Number of patients requiring rescue analgesia was significantly (P < 0.001) lower in group D (54.7% (35)) than group C (100.0% (64)). The time for first request for analgesia was significantly (P < 0.001) longer in group D (11.31 ± 6.944) than in group C (5.91 ± 4.839) h. Pain score was significantly higher in group C than D at three (P < 0.001), and six (P = 0.001) hours (P = 0.001) postoperatively. CONCLUSION Dexmedetomidine significantly improves the analgesic quality of WALANT when added to lidocaine with less opioid consumption. TRIAL REGISTRATION (ID: PACTR202203906027106; Date: 31/07/2023).
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Affiliation(s)
- Mahmoud Mohammed Alseoudy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Abdelsalam Aref St., Mansoura City, El-Dakahliya Governorate, Egypt.
| | - Elsayed Mohamed Abdelkarime
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Abdelsalam Aref St., Mansoura City, El-Dakahliya Governorate, Egypt
| | - Khaled Nour
- Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - May Elsherbiny Badr
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Abdelsalam Aref St., Mansoura City, El-Dakahliya Governorate, Egypt
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Lian X, Zhang X, Chen W, Xue F, Wang G. Dexmedetomidine mitigates neuroinflammation in an Alzheimer's disease mouse model via the miR-204-3p/FBXL7 signaling axis. Brain Res 2024; 1822:148612. [PMID: 37778649 DOI: 10.1016/j.brainres.2023.148612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/28/2023] [Indexed: 10/03/2023]
Abstract
Alzheimer's disease (AD) is a prevalent neurodegenerative disorder characterized by neuroinflammation. Dexmedetomidine (Dex) is known for its neuroprotective properties in clinical settings. In this study, we investigated the potential of Dex in protecting against neuroinflammation in an AD mouse model induced by amyloid-beta (Aβ) injection. First, in the AD mouse model, Aβ injection were administered, and the model was confirmed through behavioral tests, including the Morris water maze and Y-maze. Neuroinflammatory states in Aβ-injected mice were assessed using hematoxylin and eosin staining and enzyme-linked immunosorbent assay. Expression levels of microRNA (miR)-204-3p and F-box/LRR-repeat protein 7 (FBXL7) in mouse tissues were determined through real-time quantitative polymerase chain reaction and Western blot. The binding interaction between miR-204-3p and FBXL7 was elucidated using dual-luciferase analysis. Aβ-injected mice exhibited cognitive impairment, neuroinflammation, and downregulated miR-204-3p. Upregulation of miR-204-3p reduced inflammatory infiltration and mitigated neuroinflammation in Aβ-injected mice. Dex treatment reduced inflammation in hippocampal tissues of Aβ-injected mice. Dex treatment upregulated miR-204-3p, leading to suppressed FBXL7 expression in tissues. Inhibition of miR-204-3p or overexpression of FBXL7 reversed the alleviating effect of Dex on neuroinflammation in Aβ-injected mice. Overall, Dex increased miR-204-3p expression, resulting in the inhibition of FBXL7, and subsequently alleviated neuroinflammation in Aβ-injected mice.
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Affiliation(s)
- Xia Lian
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Xiaomin Zhang
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Wenchao Chen
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Fang Xue
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Gaiqing Wang
- The Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi 030001, China; Department of Neurology, Sanya Central Hospital (Hainan Third People's Hospital), Hainan Medical University, Sanya, Hainan 572000, China.
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Seong H, Jeong D, Kim EH, Yoon KS, Na D, Yoon SZ, Cho JE. MicroRNA-323-5p Involved in Dexmedetomidine Preconditioning Impart Neuroprotection. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1518. [PMID: 37763638 PMCID: PMC10532972 DOI: 10.3390/medicina59091518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Cerebral ischemia is one of the major preoperative complications. Dexmedetomidine is a well-known sedative-hypnotic agent that has potential organ-protective effects. We examine the miRNAs associated with preconditioning effects of dexmedetomidine in cerebral ischemia. Materials and Methods: Transient infarcts were induced in mice via reperfusion after temporary occlusion of one side of the middle cerebral artery. A subset of these mice was exposed to dexmedetomidine prior to cerebral infarction and miRNA profiling of the whole brain was performed. We administered dexmedetomidine and miRNA-323-5p mimic/inhibitor to oxygen-glucose deprivation/reoxygenation astrocytes. Additionally, we administered miR-323-5p mimic and inhibitor to mice via intracerebroventricular injection 2 h prior to induction of middle cerebral artery occlusion. Results: The infarct volume was significantly lower in the dexmedetomidine-preconditioned mice. Analysis of brain samples revealed an increased expression of five miRNAs and decreased expression of three miRNAs in the dexmedetomidine-pretreated group. The viability of cells significantly increased and expression of miR-323-5p was attenuated in the dexmedetomidine-treated oxygen-glucose deprivation/reoxygenation groups. Transfection with anti-miR-323-5p contributed to increased astrocyte viability. When miRNA-323-5p was injected intraventricularly, infarct volume was significantly reduced when preconditioned with the miR-323-5p inhibitor compared with mimic and negative control. Conclusions: Dexmedetomidine has a protective effect against transient neuronal ischemia-reperfusion injury and eight specific miRNAs were profiled. Also, miRNA-323-5p downregulation has a cell protective effect under ischemic conditions both in vivo and in vitro. Our findings suggest the potential of the miR-323-5p inhibitor as a therapeutic agent against cerebral infarction.
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Affiliation(s)
- Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Daun Jeong
- Institute for Healthcare Service Innovation, Korea University, Seoul 02841, Republic of Korea
| | - Eung Hwi Kim
- Institute for Healthcare Service Innovation, Korea University, Seoul 02841, Republic of Korea
| | - Kyung Seob Yoon
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Donghyun Na
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Jang Eun Cho
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Marchionne G, Alcoverro E, Spinillo S, Louro LF. Anaesthetic management in a cat undergoing emergency craniotomy for meningioma excision. JFMS Open Rep 2023; 9:20551169231192287. [PMID: 37744284 PMCID: PMC10517613 DOI: 10.1177/20551169231192287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Case summary A 15-year-old female spayed domestic shorthair cat underwent an emergency craniotomy to remove an intracranial meningioma causing marked midline shift, caudal transtentorial and foramen magnum herniation. Because intracranial structures are enclosed in the cranium, any volume-occupying lesions might raise intracranial pressure (ICP), compromising cerebral perfusion. Relevance and novel information This case report discusses the anaesthetic management of a cat that presented with marked bradycardia and concomitant hypotension. Cushing's reflex (CR) is a well-recognised cardiovascular reflex following sudden ICP increase, and it features an irregular breathing pattern and increased arterial blood pressure with reflex bradycardia. However, CR is reported to have a low sensitivity for the detection of raised ICP in humans with traumatic brain injury. In a previous study reporting seven cats undergoing surgical removal of intracranial meningioma, ICP was measured in four cases and, in these patients, CR was not observed during surgery. Because bradycardia was not secondary to hypertension, in this case, it might have been the result of direct compression of the nucleus of the vagus nerve. Based on the literature search, there is paucity of reports of cardiovascular changes in cats with increased ICP and their perianaesthetic management.
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Affiliation(s)
| | | | | | - Luis Filipe Louro
- ChesterGates Veterinary Specialists, Chester, UK
- Veterinary Anaesthesia Consultancy Services Limited, Barnsley, UK
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Liu H, Gao M, Zheng Y, Sun C, Lu Q, Shao D. Effects of dexmedetomidine at different dosages on perioperative haemodynamics and postoperative recovery quality in elderly patients undergoing hip replacement surgery under general anaesthesia: a randomized controlled trial. Trials 2023; 24:386. [PMID: 37291651 DOI: 10.1186/s13063-023-07384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Dexmedetomidine could provide some advantages to prevent postoperative complications in elderly patients undergoing under general anaesthesia. However, dexmedetomidine inhibits haemodynamics to some extent due to its sympathetic inhibition. OBJECTIVE To evaluate the effects of different doses of dexmedetomidine on haemodynamics during surgery and recovery after general anaesthesia in elderly patients undergoing hip replacement. METHODS This was a prospective randomized double-blind controlled clinical trial. Eligible patients were randomly allocated into comparative groups (normal saline (NS) and midazolam (MD), n = 30) and dexmedetomidine groups at different doses (D0.25/D0.5/D0.75, n = 30). In the D0.25/D0.5/D0.75 groups, dexmedetomidine was administered at different initial loading doses (0.25/0.5/0.75 μg/kg for 15 min) following 0.5 μg/kg/h continuous infusion until the end of the operation. In the MD group, patients were administered 0.03 mg/kg midazolam at the beginning of anaesthesia induction. RESULTS Compared to the MD and NS groups, there were significant decreases in MAP in the D0.5 and D0.75 groups at many time points, such as skin incision, end of operation, and from extubation until 30 min after extubation (P < 0.05); there were also significant decreases in HR in the D0.5 and D0.75 groups at time points including anaesthesia induction, end of operation, and from extubation to 2 h after operation (P < 0.05). In the D0.25 group, there were few differences in the changes in MAP and HR compared to the MD and NS groups during the entire perioperative period (P > 0.05). Moreover, the percentage of patients whose MAP and HR decreased > 20% of baseline was higher in the D0.75 and D0.5 groups than that in all other groups. Compared to the NS group, from the beginning to the end of the operation, the 95% confidence interval (CI) of RR for MAP below > 20% of baseline in the D0.5 and D0.75 groups was greater than 1. In particular, the CI of the RR in the D0.75 group was greater than 1 until the patient awoke from general anaesthesia (P < 0.05). In addition, the CI of the RR for HR below > 20% of baseline in the D0.5 group was greater than 1 compared to the NS group at the time of induction and extubation (P < 0.05). There was no significant difference in the possibility of developing hypotension or bradycardia in the MD or D0.25 groups compared to the NS group (P > 0.05). The recovery quality of patients during the post-anaesthesia period was also observed. No differences were observed among all the groups in the time to awakening or extubation after general anaesthesia (P > 0.05). According to the Riker Sedation-agitated Scale, dexmedetomidine significantly alleviated emergency agitation or delirium compared to NS (P < 0.05). In addition, the scores in the D0.5 and D0.75 groups were lower than those in the D0.25 group (P < 0.05). CONCLUSION Dexmedetomidine could alleviate the agitation of elderly patients undergoing hip replacement after intravenous general anaesthesia combined with inhaled sevoflurane without delayed recovery. However, it is necessary to be vigilant about the haemodynamic inhibition of the drug at high dosages throughout the perioperative period. Dexmedetomidine 0.25-0.5 μg/kg as the initial loading dose followed by 0.5 μg/kg/h continuous infusion might provide comfortable recovery after general anaesthesia with slight haemodynamic inhibition. TRAIL REGISTRATION ClinicalTrial.gov, No. NCT05567523. Registered 05 October 2022, https://clinicaltrials.gov/ct2/show/NCT05567523?term=NCT05567523&draw=2&rank=1 .
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Affiliation(s)
- Haitong Liu
- Department of Anesthesiology, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China
| | - Mingjie Gao
- Department of Orthopedics, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China.
| | - Yongfeng Zheng
- Department of Anesthesiology, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China
| | - Caixia Sun
- Department of Anesthesiology, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China
| | - Qinyuan Lu
- Department of Anesthesiology, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China
| | - Donghua Shao
- Department of Anesthesiology, Zhenjiang First People's Hospital, 8 Dianli Road, Zhenjiang, Jiangsu, China
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Ma K, Bebawy JF, Hemmer LB. Multimodal Analgesia and Intraoperative Neuromonitoring. J Neurosurg Anesthesiol 2023; 35:172-176. [PMID: 36662721 DOI: 10.1097/ana.0000000000000904] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
Intraoperative neuromonitoring has been a valuable tool for ensuring the functional integrity of vital neural structures by providing real-time feedback to the operative team during procedures where neurological structures are at risk. Commonly used intravenous and inhaled anesthetic drugs are known to affect waveform parameters measured with various intraoperative neuromonitoring modalities. While the concept of opioid-sparing multimodal analgesia has gained popularity in recent years, the impact of such a strategy on intraoperative neuromonitoring remains poorly characterized, in contrast to the more well-established concepts and literature regarding the effects of other hypnotic agents on neuromonitoring quality. The purpose of this focused review is to provide an overview of the clinical evidence pertaining to the pharmacological interaction of certain multimodal analgesics with routine intraoperative neuromonitoring modalities.
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Affiliation(s)
- Kan Ma
- Department of Anesthesiology and Pain Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - John F Bebawy
- Anesthesiology & Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Laura B Hemmer
- Anesthesiology & Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Paquin-Lanthier G, Subramaniam S, Leong KW, Daniels A, Singh K, Takami H, Chowdhury T, Bernstein M, Venkatraghavan L. Risk Factors and Characteristics of Intraoperative Seizures During Awake Craniotomy: A Retrospective Cohort Study of 562 Consecutive Patients With a Space-occupying Brain Lesion. J Neurosurg Anesthesiol 2023; 35:194-200. [PMID: 34411059 DOI: 10.1097/ana.0000000000000798] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Intraoperative seizures (IOSs) during awake craniotomy (AC) are associated with significant morbidity. The reported incidence of IOS is between 3% and 30%. The aim of this study was to identify risk factors for IOS during AC for elective resection or biopsy of a space-occupying brain lesion. METHODS In this retrospective study, we reviewed the records of all awake craniotomies performed by a single neurosurgeon at a single university hospital between July 2006 and December 2018. IOS was defined as a clinically apparent seizure that occurred in the operating room and was documented in the medical records. Explanatory variables were chosen based on previously published literature on risk factors for IOS. RESULTS Five hundred and sixty-two patients had a total of 607 AC procedures during the study period; 581 cases with complete anesthesia records were included in analysis. Twenty-nine (5.0%) IOS events were reported during 29 (5%) awake craniotomies. Most seizures (27/29; 93%) were focal in nature and did not limit planned intraoperative stimulation mapping. Variables associated with IOS at a univariate P -value <0.1 (frontal location of tumor, preoperative radiotherapy, preoperative use of antiepileptic drugs, intraoperative use of dexmedetomidine, and intraoperative stimulation mapping) were included in a multivariable logistic regression. Frontal location of tumor (adjusted odds ratio: 5.68, 95% confidence interval: 2.11-15.30) and intraoperative dexmedetomidine use (adjusted odds ratio: 2.724, 95% confidence interval: 1.24-6.00) were independently associated with IOS in the multivariable analysis. CONCLUSIONS This study identified a low incidence (5%) of IOS during AC. The association between dexmedetomidine and IOS should be further studied in randomized trials as this is a modifiable risk factor.
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Affiliation(s)
| | | | | | | | | | - Hirokazu Takami
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
| | | | - Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
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Viderman D, Nabidollayeva F, Bilotta F, Abdildin YG. Comparison of dexmedetomidine and propofol for sedation in awake craniotomy: A meta-analysis. Clin Neurol Neurosurg 2023; 226:107623. [PMID: 36791589 DOI: 10.1016/j.clineuro.2023.107623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Awake craniotomy (AC) is the preferred option for the resection of tumors adjacent to eloquent cortical areas and in cases of intractable epilepsy. It is mostly used to maintain the integrity of the brain during intracranial neurosurgical procedures. Awake craniotomy requires the use of ideal anesthetics, hypnotics, and analgesics to balance sedation, prompt the reversal of sedation, and prevent respiratory depression while maintaining communication between patient and medical team. Although a wide variety of anesthetics and hypnotics have been used for awake craniotomy over the past several decades, the optimal drug for the procedure has yet to be determined. The purpose of this meta-analysis was to compare dexmedetomidine and propofol in terms of intraoperative adverse events (i.e., hypertension, hypotension, nausea, vomiting, respiratory depression), patient and surgeon satisfaction, and procedure duration. METHODS We searched PubMed, Google Scholar, and the Cochrane Library for relevant articles published between the inception of these databases and April of 2022. The systematic search yielded 781 articles. After screening, we excluded 778 articles. The remaining three articles reporting 138 patients were selected for meta-analysis. RESULTS This meta-analysis showed no statistically significant difference between propofol and dexmedetomidine related to intraoperative adverse events, patient satisfaction, or procedure duration. The only statistically significant result was surgeon satisfaction, which appeared to be higher in the dexmedetomidine group. CONCLUSIONS Further high-quality randomized and controlled trials are needed to find a preferred agent for intraoperative sedation in awake craniotomy.
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Affiliation(s)
- Dmitriy Viderman
- Nazarbayev University School of Medicine (NUSOM), Kerei, Zhanibek Khans Str. 5/1, Astana, Kazakhstan; Department of Anesthesiology, Intensive Care, and Pain Medicine, National Research Oncology Center, Kerey and Zhanibek Khans Str. 3, Astana 020000, Kazakhstan.
| | - Fatima Nabidollayeva
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan.
| | - Federico Bilotta
- Department of Anesthesia and Intensive Care, University La Sapienza, Rome, Italy.
| | - Yerkin G Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan.
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Mu B, Xu W, Li H, Suo Z, Wang X, Zheng Y, Tian Y, Zhang B, Yu J, Tian N, Lin N, Zhao D, Zheng Z, Zheng H, Ni C. Determination of the effective dose of dexmedetomidine to achieve loss of consciousness during anesthesia induction. Front Med (Lausanne) 2023; 10:1158085. [PMID: 37153107 PMCID: PMC10159180 DOI: 10.3389/fmed.2023.1158085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Dexmedetomidine (DEX) is a sedative with greater preservation of cognitive function, reduced respiratory depression, and improved patient arousability. This study was designed to investigate the performance of DEX during anesthesia induction and to establish an effective DEX induction strategy, which could be valuable for multiple clinical conditions. Methods Patients undergoing abdominal surgery were involved in this dose-finding trial. Dixon's up-and-down sequential method was employed to determine the effective dose of DEX to achieve the state of "loss of consciousness", and an effective induction strategy was established with continuous infusion of DEX and remifentanil. The effects of DEX on hemodynamics, respiratory state, EEG, and anesthetic depth were monitored and analyzed. Results Through the strategy mentioned, the depth of surgical anesthesia was successfully achieved by DEX-led anesthesia induction. The ED50 and ED95 of the initial infusion rate of DEX were 0.115 and 0.200 μg/kg/min, respectively, and the mean induction time was 18.3 min. The ED50 and ED95 of DEX to achieve the state of "loss of consciousness" were 2.899 (95% CI: 2.703-3.115) and 5.001 (95% CI: 4.544-5.700) μg/kg, respectively. The mean PSI on the loss of consciousness was 42.8 among the patients. During anesthesia induction, the hemodynamics including BP and HR were stable, and the EEG monitor showed decreased α and β powers and increased θ and δ in the frontal and pre-frontal cortices of the brain. Conclusion This study indicated that continuous infusion of combined DEX and remifentanil could be an effective strategy for anesthesia induction. The EEG during the induction was similar to the physiological sleep process.
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Affiliation(s)
- Bing Mu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjie Xu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyi Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zizheng Suo
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoxiao Wang
- Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing, China
| | - Yuxiang Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Tian
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Yu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Naiyuan Tian
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Lin
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Zhao
- Department of Gynecology Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Hui Zheng
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Cheng Ni
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12
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Amlong C, Rusy D, Sanders RD, Lake W, Raz A. Dexmedetomidine depresses neuronal activity in the subthalamic nucleus during deep brain stimulation electrode implantation surgery. BJA OPEN 2022; 3:100088. [PMID: 37588575 PMCID: PMC10430856 DOI: 10.1016/j.bjao.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/03/2022] [Indexed: 08/18/2023]
Abstract
Background Micro-electrode recordings are often necessary during electrode implantation for deep brain stimulation of the subthalamic nucleus. Dexmedetomidine may be a useful sedative for these procedures, but there is limited information regarding its effect on neural activity in the subthalamic nucleus and on micro-electrode recording quality. Methods We recorded neural activity in five patients undergoing deep brain stimulation implantation to the subthalamic nucleus. Activity was recorded after subthalamic nucleus identification while patients received dexmedetomidine sedation (loading - 1 μg kg-1 over 10-15 min, maintenance - 0.7 μg kg-1 h-1). We compared the root-mean square (RMS) and beta band (13-30 Hz) oscillation power of multi-unit activity recorded by microelectrode before, during and after recovery from dexmedetomidine sedation. RMS was normalised to values recorded in the white matter. Results Multi-unit activity decreased during sedation in all five patients. Mean normalised RMS decreased from 2.8 (1.5) to 1.6 (1.1) during sedation (43% drop, p = 0.056). Beta band power dropped by 48.4%, but this was not significant (p = 0.15). Normalised RMS values failed to return to baseline levels during the time allocated for the study (30 min). Conclusions In this small sample, we demonstrate that dexmedetomidine decreases neuronal firing in the subthalamic nucleus as expressed in the RMS of the multi-unit activity. As multi-unit activity is a factor in determining the subthalamic nucleus borders during micro-electrode recordings, dexmedetomidine should be used with caution for sedation during these procedures. Clinical trial number NCT01721460.
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Affiliation(s)
- Corey Amlong
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert D. Sanders
- University of Sydney, Sydney, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Wendell Lake
- Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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13
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Zhang Z, Hao D. Optimal Dose of Dexmedetomidine for Preemptive Analgesia Combined with Transversus Abdominis Plane Block after Colon Cancer Surgery. J NIPPON MED SCH 2022; 89:399-404. [DOI: 10.1272/jnms.jnms.2022_89-406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zhanjun Zhang
- Department of Anesthesiology, Jiaozuo People's Hospital
| | - Danning Hao
- Department of Anesthesiology, Jiaozuo People's Hospital
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14
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He Z, Du J, Xue X, Yang L. Effects of Dexmedetomidine on Hemodynamics and Anesthesia Effect of Different Doses of General Anesthesia in Patients Undergoing Hepatobiliary Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2311869. [PMID: 35935309 PMCID: PMC9325570 DOI: 10.1155/2022/2311869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/29/2022] [Indexed: 01/09/2023]
Abstract
In order to provide corresponding anesthesia methods of hepatobiliary diseases and obtain better clinical effect, the hemodynamics and clinical efficacy are evaluated by using different doses of dexamethasone (DEX) during the operation. 97 patients undergoing general anesthesia for hepatobiliary surgery in our hospital from April 2020 to August 2021 are analyzed retrospectively. All patients are divided into G1 (n = 24), G2 (n = 24), G3 (n = 24), and control group (n = 25) according to the random number table method. The G1, G2, and G3 groups are injected with DEX 1.0 ug/kg, DEX 0.8 ug/kg, and DEX 0.5 ug/kg by intravenous infusion pump before induction of general anesthesia, and the control group is injected with 0.9%Nacl solution 10 mL. Intraoperative anesthesia time, postoperative eye opening time, and extubation time of all groups are observed, and the incidences of postoperative adverse reactions are compared. The experimental results show that during general anesthesia in the liver and gallbladder surgery, the patients with high dose of DEX can better maintain the intraoperative hemodynamic parameters, and effectively restrain the postoperative stress reaction.
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Affiliation(s)
- Zhaolong He
- Department of Anesthesiology, The People's Hospital of Kizilsuch Kirghiz Autonodour Prefecture, Xinjiang 845350, China
| | - Jianan Du
- Department of Anesthesiology, Sanya Central Hospital, Hainan Third People's Hospital, Sanya 572000, China
| | - Xiaolu Xue
- Department of Anesthesiology, The People's Hospital of Kizilsuch Kirghiz Autonodour Prefecture, Xinjiang 845350, China
| | - Liu Yang
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunmings 650000, China
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15
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Zhu Y, Pang G, Lu B, Jiang L, Rao C, Tong S. Anesthetic Effect of Dexmedetomidine in Clinical Functional Neurosurgery. DISEASE MARKERS 2022; 2022:6000388. [PMID: 35655919 PMCID: PMC9155914 DOI: 10.1155/2022/6000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Background Dexmedetomidine is a highly selective and efficient α2-adrenoceptor agonist with good antianxiety, analgesic, hypnotic, and sedative effects without causing respiratory depression. Aim To investigate the anesthetic effect of dexmedetomidine in clinical neurosurgery. Methods A total of 94 patients who received functional neurosurgical treatment in our hospital from March 2019 to October 2020 were selected and divided into the study and control groups. Routine anesthesia was adopted in the control group, while dexmedetomidine was used in the study group. Perioperative hemodynamic indicators such as mean arterial pressure, heart rate, and peripheral capillary oxygen saturation, cognitive function score, pain score VAS, stress response index level, and incidence of adverse reactions were compared between the two groups. Results Before surgery (T0), no significant differences in MAP, HR, and SpO2 were observed between the two groups. However, at the beginning of the operation (T1), 30 min after the operation (T2), and immediately after the operation (T3), these indicators in the study group were significantly higher than in the control group. The postoperative MMSE of the study group 3 d later was significantly higher than that of the control group. The VAS scores after the operation of the study group were lower than those of the control group. The serum cortisol (COR) and aldosterone (ALD) levels in the study group were not significantly different from those in the control group before surgery. The levels of each index in the two groups were higher than those before and 24 h after surgery. The incidence rate of adverse reactions in the study group was lower. Conclusion The application of dexmedetomidine in clinical functional neurosurgery is safe and can maintain hemodynamic stability and reduce the degree of stress response, cognitive impairment, and pain caused by invasive surgery.
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Affiliation(s)
- Yuanmao Zhu
- Department of Pain, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
| | - Gang Pang
- Department of Anesthesiology, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
| | - Bing Lu
- Department of Pain, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
| | - Ling Jiang
- Department of Anesthesiology, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
| | - Chuanhua Rao
- Department of Anesthesiology, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
| | - Shanshan Tong
- Department of Anesthesiology, Jiangjin Central Hospital of Chongqing, 725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China 402260
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16
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Gray K, Avitsian R, Kakumanu S, Venkatraghavan L, Chowdhury T. The Effects of Anesthetics on Glioma Progression: A Narrative Review. J Neurosurg Anesthesiol 2022; 34:168-175. [PMID: 32658099 DOI: 10.1097/ana.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/15/2020] [Indexed: 11/26/2022]
Abstract
There are many established factors that influence glioma progression, including patient age, grade of tumor, genetic mutations, extent of surgical resection, and chemoradiotherapy. Although the exposure time to anesthetics during glioma resection surgery is relatively brief, the hemodynamic changes involved and medications used, as well as the stress response throughout the perioperative period, may also influence postoperative outcomes in glioma patients. There are numerous studies that have demonstrated that choice of anesthesia influences non-brain cancer outcomes; of particular interest are those describing that the use of total intravenous anesthesia may yield superior outcomes compared with volatile agents in in vitro and human studies. Much remains to be discovered on the topic of anesthesia's effect on glioma progression.
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Affiliation(s)
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Saranya Kakumanu
- Department of Radiation Oncology, Cancer Care Manitoba, Winnipeg, MB
| | - Lashmi Venkatraghavan
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Tumul Chowdhury
- Department of Anesthesiology, Perioperative, and Pain Medicine, Health Sciences Center, University of Manitoba
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Care of the Perioperative Patient at Risk for Increased Intracranial Pressure. J Perianesth Nurs 2022; 37:274-276. [DOI: 10.1016/j.jopan.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022]
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Liu T, Qin Y, Qi H, Luo Z, Yan L, Yu P, Dong B, Zhao S, Wu X, Chang Z, Liu Z, Liu X, Yuan T, Li H, Xiao L, Wang G. A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study. Front Pharmacol 2022; 13:840320. [PMID: 35330828 PMCID: PMC8940210 DOI: 10.3389/fphar.2022.840320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The effect of a bolus dose of dexmedetomidine on intraoperative neuromonitoring (IONM) parameters during spinal surgeries has been variably reported and remains a debated topic. Methods: A randomized, double-blinded, placebo-controlled study was performed to assess the effect of dexmedetomidine (1 μg/kg in 10 min) followed by a constant infusion rate on IONM during thoracic spinal decompression surgery (TSDS). A total of 165 patients were enrolled and randomized into three groups. One group received propofol- and remifentanil-based total intravenous anesthesia (TIVA) (T group), one group received TIVA combined with dexmedetomidine at a constant infusion rate (0.5 μg kg-1 h-1) (D1 group), and one group received TIVA combined with dexmedetomidine delivered in a loading dose (1 μg kg-1 in 10 min) followed by a constant infusion rate (0.5 μg kg-1 h-1) (D2 group). The IONM data recorded before test drug administration was defined as the baseline value. We aimed at comparing the parameters of IONM. Results: In the D2 group, within-group analysis showed suppressive effects on IONM parameters compared with baseline value after a bolus dose of dexmedetomidine. Furthermore, the D2 group also showed inhibitory effects on IONM recordings compared with both the D1 group and the T group, including a statistically significant decrease in SSEP amplitude and MEP amplitude, and an increase in SSEP latency. No significance was found in IONM parameters between the T group and the D1 group. Conclusion: Dexmedetomidine delivered in a loading dose can significantly inhibit IONM parameters in TSDS. Special attention should be paid to the timing of a bolus dose of dexmedetomidine under IONM. However, dexmedetomidine delivered at a constant speed does not exert inhibitory effects on IONM data.
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Affiliation(s)
- Tun Liu
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yue Qin
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Huaguang Qi
- Department of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Zhenguo Luo
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Liang Yan
- Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Pengfei Yu
- Department of Gastrointestinal Surgery, Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Buhuai Dong
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Songchuan Zhao
- Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Xucai Wu
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Zhen Chang
- Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Zhian Liu
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Institute of Biomedical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Xuemei Liu
- Department of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Tao Yuan
- Department of Functional Inspection Section, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Houkun Li
- Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Li Xiao
- Department of Anesthesiology, Xi’an Honghui Hospital, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Gang Wang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Institute of Biomedical Engineering, Xi’an Jiaotong University, Xi’an, China
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Salem AE, El-Mawy MG, Al-Kholy AF. Multimodal, non-opioid based analgesia for women presented for laparoscopic hysterectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2031547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Ahmed E. Salem
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed G. El-Mawy
- Department of Anesthesiology & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Adel F. Al-Kholy
- Department of Medical Biochemistry, Faculty of Medicine, Benha University, Benha, Egypt
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20
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Lee CZ, Poon CCM. An Update of Neuroanesthesia for Intraoperative Brain Mapping Craniotomy. Neurosurgery 2022; 90:1-6. [PMID: 33647962 DOI: 10.1093/neuros/nyab022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/13/2020] [Indexed: 01/06/2023] Open
Abstract
The perioperative multidisciplinary team approach has probably been best exemplified by the care of awake craniotomy patients. Advancement in anesthesia and meticulous perioperative care has supported the safety and complexity of the surgical and mapping efforts in glioma resection. The discussions in this review will emphasize on anesthetic and perioperative management strategies to prevent complications and minimize their effects if they occur, including current practice guidelines in anesthesia, updates on the applications of anesthetic medications, and emerging devices. Planning the anesthetic and perioperative management is based on understanding the pharmacology of the medications, the goals of different stages of the surgery and mapping, and anticipating potential problems.
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Affiliation(s)
- Chanhung Z Lee
- Department of Anesthesia and Perioperative Care, University of California , San Francisco, San Francisco, California, USA
| | - Clara C M Poon
- Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong , Hong Kong
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21
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Chen PH, Tsuang FY, Lee CT, Yeh YC, Cheng HL, Lee TS, Chang YW, Cheng YJ, Wu CY. Neuroprotective effects of intraoperative dexmedetomidine versus saline infusion combined with goal-directed haemodynamic therapy for patients undergoing cranial surgery: A randomised controlled trial. Eur J Anaesthesiol 2021; 38:1262-1271. [PMID: 34101714 DOI: 10.1097/eja.0000000000001532] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND By inhibiting neuroinflammation dexmedetomidine may be neuroprotective in patients undergoing cranial surgery, but it reduces cardiac output and cerebral blood flow. OBJECTIVE To investigate whether intra-operative dexmedetomidine combined with goal-directed haemodynamic therapy (GDHT) has neuroprotective effects in cranial surgery. DESIGN A double-blind, single-institution, randomised controlled trial. SETTING A single university hospital, from April 2017 to April 2020. PATIENTS A total of 160 adults undergoing elective cranial surgery. INTERVENTION Infusion of dexmedetomidine (0.5 μg kg-1 h-1) or saline combined with GDHT to optimise stroke volume during surgery. MAIN OUTCOME MEASURES The proportion who developed postoperative neurological complications was compared. Postoperative disability was assessed using the Barthel Index at time points between admission and discharge, and also the 30-day modified Rankin Scale (mRS). Postoperative delirium was assessed. The concentration of a peri-operative serum neuroinflammatory mediator, high-mobility group box 1 protein (HMGB1), was compared. RESULTS Fewer patients in the dexmedetomidine group developed new postoperative neurological complications (26.3% vs. 43.8%; P = 0.031), but the number of patients developing severe neurological complications was comparable between the two groups (11.3% vs. 20.0%; P = 0.191). In the dexmedetomidine group the Barthel Index reduction [0 (-10 to 0)] was less than that in the control group [-5 (-15 to 0)]; P = 0.023, and there was a more favourable 30-day mRS (P = 0.013) with more patients without postoperative delirium (84.6% vs. 64.2%; P = 0.012). Furthermore, dexmedetomidine induced a significant reduction in peri-operative serum HMGB1 level from the baseline (222.5 ± 408.3 pg ml-1) to the first postoperative day (152.2 ± 280.0 pg ml-1) P = 0.0033. There was no significant change in the control group. The dexmedetomidine group had a lower cardiac index than did the control group (3.0 ± 0.8 vs. 3.4 ± 1.8 l min-1 m-2; P = 0.0482) without lactate accumulation. CONCLUSIONS Dexmedetomidine infusion combined with GDHT may mitigate neuroinflammation without undesirable haemodynamic effects during cranial surgery and therefore be neuroprotective. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02878707.
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Affiliation(s)
- Pin-Hsin Chen
- From the Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan (P-HC, C-TL, Y-CY, H-LC, T-SL, Y-WC, Y-JC, C-YW) and Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan (F-YT)
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22
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Wang D, Li R, Li S, Wang J, Zeng M, Dong J, Liu X, Lin N, Peng Y. Effect of dexmedetomidine on postoperative delirium in patients undergoing brain tumour resections: study protocol of a randomised controlled trial. BMJ Open 2021; 11:e051584. [PMID: 34758995 PMCID: PMC8587577 DOI: 10.1136/bmjopen-2021-051584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/12/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Postoperative delirium (POD) is a common complication. The incidence of POD is about 25% in non-cardiac surgery and ranges from 10% to 30% in neurological procedures. A lot of trials show that dexmedetomidine might help to reduce the incidence of delirium in patients undergoing non-cardiac surgery. However, the impact of dexmedetomidine on POD for patients undergoing craniotomy and tumour resections remains unclear. METHODS AND ANALYSIS The study is a prospective, single-centre, randomised, double-blinded, paralleled-group controlled trial. Patients undergoing elective frontotemporal tumour resections will be randomly assigned to the dexmedetomidine group and the control group. After endotracheal intubation, patients in the dexmedetomidine group will be administered with a loading dose of dexmedetomidine 0.6 µg/kg in 10 min followed by continuous infusion at a rate of 0.4 µg/kg/hour until the start of dural closure. In the control group, patients will receive the identical volume of normal saline in the same setting. The primary outcome will be the cumulative incidence of POD within 5 days. The delirium assessment will be performed by using the confusion assessment method in the first 5 consecutive days after surgery. Secondary outcomes include the pain severity assessed by Numerical Rating Scale pain score, quality of postoperative sleep assessed by the Richards Campbell sleep questionnaire and postoperative quality of recovery from anaesthesia by the Postoperative Quality Recovery Scale. ETHICS AND DISSEMINATION The protocol (V.1.0, 10 November 2020) has been approved by the Ethics Review Committee of the Chinese Clinical Trial Registry (number ChiECRCT-20200436). The findings of the study will be disseminated in a peer-reviewed journal and at a scientific conference. TRIAL REGISTRATION NUMBER NCT04674241.
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Affiliation(s)
- Dexiang Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Ruowen Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Juan Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Jia Dong
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Nan Lin
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Beijing, China
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Hu G, Shi Z, Shao W, Xu B. MicroRNA-214-5p involves in the protection effect of Dexmedetomidine against neurological injury in Alzheimer's disease via targeting the suppressor of zest 12. Brain Res Bull 2021; 178:164-172. [PMID: 34715270 DOI: 10.1016/j.brainresbull.2021.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/31/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) is a neurological disease. Dexmedetomidine (Dex) has been evidenced to exert neuroprotective effects on multiple neurological diseases, while the function of microRNA(miR)- 214-5p on Dex-mediated AD progression via targeting the suppressor of zest 12 (SUZ12) remains unclear. This study obligates to investigate the regulatory functions of Dex, miR-214-5p and SUZ12 on AD. METHODS The expression of miR-214-5p and SUZ12 in APPswe/PS1dE9 mice (hereinafter referred to as AD mice) was examined. Thereafter, the AD mice were treated with Dex or increased miR-214-5p or reduced SUZ12 to determine the spatial memory ability, apoptosis of hippocampal neurons and the contents of serum inflammatory and oxidative stress factors of AD mice. Finally, the target relationship between miR-214-5p and SUZ12 was detected. RESULTS MiR-214-5p was reduced and SUZ12 was elevated in AD mice. Dex administration reduced the apoptosis of hippocampal neurons, the contents of serum inflammatory factor and oxidative stress, and attenuated the cognitive impairment of AD mice accompanied by up-regulated miR-214-5p and down-regulated SUZ12, and the overexpression of miR-214-5p or reduction of SUZ12 could effectively enhance the Dex-treated effects on AD mice. MiR-214-5p targeted SUZ12. CONCLUSION Dex may have a potential neuroprotective effect on AD via the miR-214-5p/SUZ12 axis. This study provides novel therapeutic targets for AD treatment.
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Affiliation(s)
- Guangjun Hu
- The first clinical college of Southern Medical University, Guangzhou 430060, Guangdong Province, China; Department of Anesthesiology, Wuhan third Hospital/Tongren Hospital of Wuhan University, Wuhan, Hubei Province, China; Department of Anesthesiology, General Hospital of the Southern Theater Command of the Chinese PLA, Guangzhou 510010, Guangdong Province, China
| | - Zhen Shi
- Department of pain treatment, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, Hubei Province, China; Hubei Hospital of Traditional Chinese Medicine, Affiliated Hospital of Hubei University of Traditional Chinese Medicine, Wuhan, Hubei Province, China
| | - Weidong Shao
- Department of Anesthesiology, General Hospital of the Southern Theater Command of the Chinese PLA, Guangzhou 510010, Guangdong Province, China
| | - Bo Xu
- The first clinical college of Southern Medical University, Guangzhou 430060, Guangdong Province, China; Department of Anesthesiology, General Hospital of the Southern Theater Command of the Chinese PLA, Guangzhou 510010, Guangdong Province, China.
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Li Z, Li C, Zhang M. Effect of dexmedetomidine on hemodynamics in patients undergoing hysterectomy: a meta-analysis and systematic review. J Int Med Res 2021; 49:3000605211039809. [PMID: 34433340 PMCID: PMC8404640 DOI: 10.1177/03000605211039809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective We conducted a meta-analysis and systematic review to evaluate the effects of dexmedetomidine on the hemodynamics of patients undergoing hysterectomy. Methods We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials databases for clinical randomized controlled trials (RCTs) that allowed direct or indirect comparisons of hemodynamic indicators. We also searched nine English-language databases up to April 2021 to identify relevant research. The Cochrane risk-of-bias tool for RCTs was applied to assess the methodological quality of the eligible studies. The meta-analysis was conducted using RevMan 5.4 software. Results Nine trials were included in this systematic review. The effect of dexmedetomidine on heart rate during surgery was significantly smaller than that of other sedatives. Intraoperative systolic and diastolic blood pressure and mean arterial pressure were more stable in the dexmedetomidine group compared with the control group. The postoperative modified Observer’s Assessment of Alertness Score was also better in the dexmedetomidine compared with the control group. Conclusions Dexmedetomidine increases hemodynamic stability in patients undergoing hysterectomy, reduces the cardiovascular stress response during surgery, and effectively prevents postoperative adverse reactions, with good safety.
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Affiliation(s)
- Zhaoqiu Li
- Surgical Anesthesia Center, Sanya Maternal and Child Health Hospital, Sanya, Hainan, China
| | - Cuiping Li
- Department of Anesthesiology, Dongguan Houjie Hospital, Dongguan, Guangdong, China
| | - Maoxian Zhang
- Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
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Hayashi T, Hou Y, Glasser MF, Autio JA, Knoblauch K, Inoue-Murayama M, Coalson T, Yacoub E, Smith S, Kennedy H, Van Essen DC. The nonhuman primate neuroimaging and neuroanatomy project. Neuroimage 2021; 229:117726. [PMID: 33484849 PMCID: PMC8079967 DOI: 10.1016/j.neuroimage.2021.117726] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022] Open
Abstract
Multi-modal neuroimaging projects such as the Human Connectome Project (HCP) and UK Biobank are advancing our understanding of human brain architecture, function, connectivity, and their variability across individuals using high-quality non-invasive data from many subjects. Such efforts depend upon the accuracy of non-invasive brain imaging measures. However, 'ground truth' validation of connectivity using invasive tracers is not feasible in humans. Studies using nonhuman primates (NHPs) enable comparisons between invasive and non-invasive measures, including exploration of how "functional connectivity" from fMRI and "tractographic connectivity" from diffusion MRI compare with long-distance connections measured using tract tracing. Our NonHuman Primate Neuroimaging & Neuroanatomy Project (NHP_NNP) is an international effort (6 laboratories in 5 countries) to: (i) acquire and analyze high-quality multi-modal brain imaging data of macaque and marmoset monkeys using protocols and methods adapted from the HCP; (ii) acquire quantitative invasive tract-tracing data for cortical and subcortical projections to cortical areas; and (iii) map the distributions of different brain cell types with immunocytochemical stains to better define brain areal boundaries. We are acquiring high-resolution structural, functional, and diffusion MRI data together with behavioral measures from over 100 individual macaques and marmosets in order to generate non-invasive measures of brain architecture such as myelin and cortical thickness maps, as well as functional and diffusion tractography-based connectomes. We are using classical and next-generation anatomical tracers to generate quantitative connectivity maps based on brain-wide counting of labeled cortical and subcortical neurons, providing ground truth measures of connectivity. Advanced statistical modeling techniques address the consistency of both kinds of data across individuals, allowing comparison of tracer-based and non-invasive MRI-based connectivity measures. We aim to develop improved cortical and subcortical areal atlases by combining histological and imaging methods. Finally, we are collecting genetic and sociality-associated behavioral data in all animals in an effort to understand how genetic variation shapes the connectome and behavior.
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Affiliation(s)
- Takuya Hayashi
- Laboratory for Brain Connectomics Imaging, RIKEN Center for Biosystems Dynamics Research, 6-7-3 MI R&D Center 3F, Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan; Department of Neurobiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yujie Hou
- Inserm, Stem Cell and Brain Research Institute U1208, Univ Lyon, Université Claude Bernard Lyon 1, Bron, France
| | - Matthew F Glasser
- Department of Neuroscience, Washington University Medical School, St Louis, MO USA; Department of Neuroscience and Radiology, Washington University Medical School, St Louis, MO USA
| | - Joonas A Autio
- Laboratory for Brain Connectomics Imaging, RIKEN Center for Biosystems Dynamics Research, 6-7-3 MI R&D Center 3F, Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Kenneth Knoblauch
- Inserm, Stem Cell and Brain Research Institute U1208, Univ Lyon, Université Claude Bernard Lyon 1, Bron, France
| | | | - Tim Coalson
- Department of Neuroscience, Washington University Medical School, St Louis, MO USA
| | - Essa Yacoub
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, USA
| | - Stephen Smith
- Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Henry Kennedy
- Inserm, Stem Cell and Brain Research Institute U1208, Univ Lyon, Université Claude Bernard Lyon 1, Bron, France; Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences (CAS) Key Laboratory of Primate Neurobiology, CAS, Shanghai, China
| | - David C Van Essen
- Department of Neuroscience, Washington University Medical School, St Louis, MO USA
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Neuroanesthesiology Update. J Neurosurg Anesthesiol 2021; 33:107-136. [PMID: 33480638 DOI: 10.1097/ana.0000000000000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022]
Abstract
This review summarizes the literature published in 2020 that is relevant to the perioperative care of neurosurgical patients and patients with neurological diseases as well as critically ill patients with neurological diseases. Broad topics include general perioperative neuroscientific considerations, stroke, traumatic brain injury, monitoring, anesthetic neurotoxicity, and perioperative disorders of cognitive function.
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The role of dexmedetomidine in neurosurgery. Best Pract Res Clin Anaesthesiol 2020; 35:221-229. [PMID: 34030806 DOI: 10.1016/j.bpa.2020.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 01/14/2023]
Abstract
Dexmedetomidine can be used for sedation and analgesia and has been approved for this use by the European Medicines Agency since 2017. It causes an arousable state of sedation, which is beneficial during neurosurgical procedures that require the patient to cooperate with neurological tests (i.e. tumor surgery or implantation of deep brain stimulators). During procedures where monitoring of somatosensory evoked potentials and/or motor evoked potentials is required, dexmedetomidine can be used as an adjunct to general anesthesia with GABAergic drugs to decrease the dose of the latter when these drugs impair the monitoring signals. The use of dexmedetomidine has also been associated with neuroprotective effects and a decreased incidence of delirium, but studies confirming these effects in the peri-operative (neuro-)surgical setting are lacking. Although dexmedetomidine does not cause respiratory depression, its hemodynamic effects are complex and careful patient selection, choice of dose, and monitoring must be performed.
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Shi HX, Du XJ, Wu F, Hu YJ, Mi WD. Dexmedetomidine for early postoperative cognitive dysfunction after video-assisted thoracoscopic lobectomy in elderly male patients with lung cancer. Medicine (Baltimore) 2020; 99:e21691. [PMID: 32899001 PMCID: PMC7478426 DOI: 10.1097/md.0000000000021691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This retrospective study explored the efficacy and safety of dexmedetomidine in treating early postoperative cognitive dysfunction (EPPNCD) after video-assisted thoracoscopic lobectomy (VATL) in elderly male patients with lung cancer (LC).This study included a total of 80 elderly male patients with LC who received VATL. All of them were equally assigned to a treatment group and a control group, with 40 patients each group. The primary outcome included cognitive dysfunction, as evaluated by mini-mental state examination scale. The secondary outcomes consisted of incidence of EPPNCD, lung function (as measured by forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow, and maximal voluntary ventilation), and adverse events. All outcome data were analyzed before and 3 days after surgery.After surgery, all patients in the treatment group exerted better efficacy in mini-mental state examination scale (P < .01) and incidence of EPPNCD (P = .03), than patients in the control group. However, no significant differences were detected in forced vital capacity (P = .65), forced expiratory volume in 1 second (P = .50), peak expiratory flow (P = .73), and maximal voluntary ventilation (P = .27) between 2 groups. In addition, there is similar safety profile between 2 groups.The findings of this study showed that dexmedetomidine may benefit EPPNCD after VATL in elderly male patients with LC. Future studies are needed to warrant the present conclusions.
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Affiliation(s)
- Hai-Xia Shi
- Department of Anesthesiology, Chinese PLA General Hospital, Beijing
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xue-Jiang Du
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Fan Wu
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ya-Juan Hu
- Department of Anesthesiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Wei-Dong Mi
- Department of Anesthesiology, Chinese PLA General Hospital, Beijing
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Kim SH, Choi SH. Anesthetic considerations for awake craniotomy. Anesth Pain Med (Seoul) 2020; 15:269-274. [PMID: 33329824 PMCID: PMC7713838 DOI: 10.17085/apm.20050] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.
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Affiliation(s)
- Seung Hyun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Ho Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Dexmedetomidine Activation of Dopamine Neurons in the Ventral Tegmental Area Attenuates the Depth of Sedation in Mice. Anesthesiology 2020; 133:377-392. [DOI: 10.1097/aln.0000000000003347] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background
Dexmedetomidine induces a sedative response that is associated with rapid arousal. To elucidate the underlying mechanisms, the authors hypothesized that dexmedetomidine increases the activity of dopaminergic neurons in the ventral tegmental area, and that this action contributes to the unique sedative properties of dexmedetomidine.
Methods
Only male mice were used. The activity of ventral tegmental area dopamine neurons was measured by a genetically encoded Ca2+ indicator and patch-clamp recording. Dopamine neurotransmitter dynamics in the medial prefrontal cortex and nucleus accumbens were measured by a genetically encoded dopamine sensor. Ventral tegmental area dopamine neurons were inhibited or activated by a chemogenetic approach, and the depth of sedation was estimated by electroencephalography.
Results
Ca2+ signals in dopamine neurons in the ventral tegmental area increased after intraperitoneal injection of dexmedetomidine (40 μg/kg; dexmedetomidine, 16.917 [14.882; 21.748], median [25%; 75%], vs. saline, –0.745 [–1.547; 0.359], normalized data, P = 0.001; n = 6 mice). Dopamine transmission increased in the medial prefrontal cortex after intraperitoneal injection of dexmedetomidine (40 μg/kg; dexmedetomidine, 10.812 [9.713; 15.104], median [25%; 75%], vs. saline, –0.498 [–0.664; –0.355], normalized data, P = 0.001; n = 6 mice) and in the nucleus accumbens (dexmedetomidine, 8.543 [7.135; 11.828], median [25%; 75%], vs. saline, –0.329 [–1.220; –0.047], normalized data, P = 0.001; n = 6 mice). Chemogenetic inhibition or activation of ventral tegmental area dopamine neurons increased or decreased slow waves, respectively, after intraperitoneal injection of dexmedetomidine (40 μg/kg; delta wave: two-way repeated measures ANOVA, F[2, 33] = 8.016, P = 0.002; n = 12 mice; theta wave: two-way repeated measures ANOVA, F[2, 33] = 22.800, P < 0.0001; n = 12 mice).
Conclusions
Dexmedetomidine activates dopamine neurons in the ventral tegmental area and increases dopamine concentrations in the related forebrain projection areas. This mechanism may explain rapid arousability upon dexmedetomidine sedation.
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
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Kang R, Jeong JS, Ko JS, Lee SY, Lee JH, Choi SJ, Cha S, Lee JJ. Intraoperative dexmedetomidine attenuates norepinephrine levels in patients undergoing transsphenoidal surgery: a randomized, placebo-controlled trial. BMC Anesthesiol 2020; 20:100. [PMID: 32359367 PMCID: PMC7195722 DOI: 10.1186/s12871-020-01025-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Dexmedetomidine has sympatholytic effects. We investigated whether dexmedetomidine could attenuate stress responses in patients undergoing endoscopic transnasal transseptal transsphenoidal surgery. Methods Forty-six patients were randomized to receive a continuous infusion of 0.9% saline (n = 23) or dexmedetomidine (n = 23). Immediately after general anesthesia induction, the dexmedetomidine group received a loading dose of 1 mcg/kg dexmedetomidine over 10 min, followed by a maintenance dose of 0.2–0.7 mcg/kg/h and the control group received 0.9% saline at the same volume until 30 min before the end of surgery. Serum levels of epinephrine, norepinephrine, and glucose were assessed before surgery (T1) and the end of drug infusion (T2). The primary outcome was the change in norepinephrine levels between the two time points. Results Changes (T2-T1 values) in perioperative serum norepinephrine levels were significantly greater in the dexmedetomidine group than in the control group (median difference, 56.9 pg/dL; 95% confidence interval, 20.7 to 83.8 pg/dL; P = 0.002). However, epinephrine level changes did not show significant intergroup differences (P = 0.208). Significantly fewer patients in the dexmedetomidine group than in the control group required rescue analgesics at the recovery area (4.3% vs. 30.4%, P = 0.047). Conclusions Intraoperative dexmedetomidine administration reduced norepinephrine release and rescue analgesic requirement. Dexmedetomidine might be used as an anesthetic adjuvant in patients undergoing transnasal transseptal transsphenoidal surgery. Trial registration Clinical Trial Registry of Korea, identifier: KCT0003366; registration date: 21/11/2018; presenting author: Ji Seon Jeong.
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Affiliation(s)
- RyungA Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea.
| | - Justin Sangwook Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
| | - Soo-Youn Lee
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
| | - Soo Joo Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
| | - Sungrok Cha
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
| | - Jeong Jin Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon ro, Gangnam gu, Seoul, 06351, South Korea
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Ma K, Uejima JL. Awake Craniotomy in a Patient With History of Post-Traumatic Stress Disorder-A Clinical Dilemma: A Case Report. A A Pract 2020; 14:140-143. [PMID: 31904626 DOI: 10.1213/xaa.0000000000001167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A 32-year-old man undergoing awake craniotomy for tumor resection was previously diagnosed with post-traumatic stress disorder (PTSD)-typically a relative contraindication for awake craniotomy. Preoperative neurocognitive assessment and counseling by a neuroanesthesiologist and neuropsychologist were undertaken to characterize his PTSD, identify triggers, and prepare him for the intraoperative events. Dexmedetomidine and remifentanil were used as intraoperative anxiolytics and analgesics. With an emphasis on open communication, the patient tolerated the awake craniotomy without complications. This case highlights the importance of multidisciplinary approach and meticulous perioperative preparation in successfully managing a patient who might otherwise be contraindicated for awake craniotomy.
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Affiliation(s)
- Kan Ma
- From the Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Abstract
This review is intended to provide a summary of the literature pertaining to the perioperative care of neurosurgical patients and patients with neurological diseases. General topics addressed in this review include general neurosurgical considerations, stroke, neurological monitoring, and perioperative disorders of cognitive function.
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Agarwal D, Chahar P, Chmiela M, Sagir A, Kim A, Malik F, Farag E. Multimodal Analgesia for Perioperative Management of Patients presenting for Spinal Surgery. Curr Pharm Des 2019; 25:2123-2132. [PMID: 31298146 DOI: 10.2174/1381612825666190708174639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/26/2019] [Indexed: 11/22/2022]
Abstract
Multimodal, non-opioid based analgesia has become the cornerstone of ERAS protocols for effective analgesia after spinal surgery. Opioid side effects, dependence and legislation restricting long term opioid use has led to a resurgence in interest in opioid sparing techniques. The increasing array of multimodal opioid sparing analgesics available for spinal surgery targeting novel receptors, transmitters, and altering epigenetics can help provide an optimal perioperative experience with less opioid side effects and long-term dependence. Epigenetic mechanisms of pain may enhance or suppress gene expression, without altering the genome itself. Such mechanisms are complex, dynamic and responsive to environment. Alterations that occur can affect the pathophysiology of pain management at a DNA level, modifying perceived pain relief. In this review, we provide a brief overview of epigenetics of pain, systemic local anesthetics and neuraxial techniques that continue to remain useful for spinal surgery, neuropathic agents, as well as other common and less common target receptors for a truly multimodal approach to perioperative pain management.
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Affiliation(s)
- Deepak Agarwal
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Praveen Chahar
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Mark Chmiela
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Afrin Sagir
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Arnold Kim
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Faysal Malik
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ehab Farag
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, United States
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