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Kondo D, Asano N, Ishiyama T, Shintani N, Matsukawa T. Effects of adrenaline and vasopressin on cerebral microcirculation at baseline and during global brain ischemia and reperfusion in rabbits. BMC Anesthesiol 2022; 22:380. [PMID: 36476578 PMCID: PMC9730607 DOI: 10.1186/s12871-022-01926-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND During cardiopulmonary resuscitation, the brain becomes ischemic. Adrenaline and vasopressin have been recommended for use during cardiopulmonary resuscitation. We aimed to investigate the direct effects of adrenaline and vasopressin on the cerebral microvasculature at baseline and during ischemia and reperfusion in rabbits. METHODS The closed cranial window method was used to visualize the cerebral microcirculation and changes in the pial arteriole diameter in rabbits. Adrenaline and vasopressin were administered topically on the brain tissue. First, the effects of adrenaline and vasopressin on pial arterioles were evaluated in 7 rabbits that were given 4 different concentrations of adrenaline, and another 7 rabbits that received 4 different concentrations of vasopressin. Second, the effects of adrenaline and vasopressin were determined during the global brain ischemia and reperfusion, which was induced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 min. An additional 21 rabbits were randomly assigned to receive artificial cerebrospinal fluid (aCSF) (n = 7), adrenaline 10-5 mol/L (n = 7), or vasopressin 10-7 mol/L (n = 7). Each drug was continuously infused from 5 min after the initiation of ischemia until 120 min after reperfusion. The pial arteriole diameters were recorded before and during ischemia, and after reperfusion. RESULTS At baseline, adrenaline and vasopressin did not affect the cerebral pial arterioles. During ischemia, vasopressin, but not aCSF and adrenaline constricted the pial vessels. Late in the reperfusion phase, pial diameter became reduced in the vasopressin and aCSF groups whereas pial diameter was higher in the animals treated with adrenaline. CONCLUSIONS Adrenaline and vasopressin did not affect pial arterioles at baseline. During reperfusion, adrenaline may counteract the cerebral vasoconstriction.
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Affiliation(s)
- Daisuke Kondo
- grid.267500.60000 0001 0291 3581Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Nobumasa Asano
- grid.267500.60000 0001 0291 3581Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
| | - Tadahiko Ishiyama
- grid.472161.70000 0004 1773 1256Surgical Center, University of Yamanashi Hospital, University of Yamanashi, Chuo, Yamanashi Japan
| | - Noriyuki Shintani
- grid.472161.70000 0004 1773 1256Surgical Center, University of Yamanashi Hospital, University of Yamanashi, Chuo, Yamanashi Japan
| | - Takashi Matsukawa
- grid.267500.60000 0001 0291 3581Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898 Japan
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Diprose WK, Wang MTM, Campbell D, Sutcliffe JA, McFetridge A, Chiou D, Lai J, Barber PA. Intravenous Propofol Versus Volatile Anesthetics For Stroke Endovascular Thrombectomy. J Neurosurg Anesthesiol 2021; 33:39-43. [PMID: 31453877 DOI: 10.1097/ana.0000000000000639] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The choice of anesthetic technique for ischemic stroke patients undergoing endovascular thrombectomy is controversial. Intravenous propofol and volatile inhalational general anesthetic agents have differing effects on cerebral hemodynamics, which may affect ischemic brain tissue and clinical outcome. We compared outcomes in patients undergoing endovascular thrombectomy with general anesthesia who were treated with propofol or volatile agents. METHODS Consecutive endovascular thrombectomy patients treated using general anesthesia were identified from our prospective database. Baseline patient characteristics, anesthetic agent, and clinical outcomes were recorded. Functional independence at 3 months was defined as a modified Rankin Scale of 0 to 2. RESULTS There were 313 patients (182 [58.1%] men; mean±SD age, 64.7±15.9 y; 257 [82%] anterior circulation), of whom 254 (81%) received volatile inhalational (desflurane or sevoflurane), and 59 (19%) received intravenous propofol general anesthesia. Patients with propofol anesthesia had more ischemic heart disease, higher baseline National Institutes of Health Stroke Scale scores, more basilar artery occlusion, and were less likely to be treated with intravenous thrombolysis. Multivariable logistic regression analysis showed that propofol anesthesia was associated with improved functional independence at 3 months (odds ratio=2.65; 95% confidence interval, 1.14-6.22; P=0.03) and a nonsignificant trend toward reduced 3-month mortality (odds ratio=0.37; 95% CI, 0.12-1.10; P=0.07). CONCLUSION In stroke patients undergoing endovascular thrombectomy treated using general anesthesia, there may be a differential effect between intravenous propofol and volatile inhalational agents. These results should be considered hypothesis-generating and be tested in future randomized controlled trials.
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Affiliation(s)
- William K Diprose
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland
- Departments of Neurology
| | - Michael T M Wang
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland
| | | | | | | | | | | | - P Alan Barber
- Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland
- Departments of Neurology
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Kaya C, Cebeci H, Tomak L, Ozbalci GS. Prospective Randomized Trial Between Propofol Intravenous and Sevoflurane Inhaled Anesthesia on Cerebral Oximetry. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cengiz Kaya
- Department of Anesthesiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Halil Cebeci
- Department of Anesthesiology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Leman Tomak
- Department of Biostatistics and Public Health, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Gokhan Selcuk Ozbalci
- Department of General Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Effects of spinal anesthesia and sedation with dexmedetomidine or propofol on cerebral regional oxygen saturation and systemic oxygenation a period after spinal injection. J Anesth 2020; 34:806-813. [PMID: 32556601 DOI: 10.1007/s00540-020-02816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate changes in cerebral regional oxygen saturation (rSO2) after spinal anesthesia and compare the changes in rSO2 and systemic oxygenation between dexmedetomidine sedation and propofol sedation. METHODS Thirty-six patients scheduled to undergo transurethral surgery under spinal anesthesia were randomly assigned to the dexmedetomidine (n = 18) and propofol groups (n = 18). We used near-infrared spectroscopy sensors to measure rSO2, and obtained data from each side were averaged. After oxygen insufflation, baseline measurements of mean arterial blood pressure (MAP), heart rate, rSO2, pulse oximetry saturation (SpO2), bispectral index, and body temperature were made. After spinal anesthesia, we measured these parameters every 5 min. Twenty minutes after spinal injection, dexmedetomidine or propofol administration was started. We measured each parameter at 10, 25, and 40 min after the administration of dexmedetomidine or propofol. RESULTS The baseline rSO2 in the dexmedetomidine group was 71.3 ± 7.3%, and that in the propofol group was 71.8 ± 5.6%. After spinal anesthesia, rSO2 in both groups decreased significantly (dexmedetomidine group: 65.4 ± 6.9%; propofol group: 64.3 ± 7.4%). After administering sedatives, rSO2 was equivalent after spinal anesthesia. rSO2 was comparable between the two groups. MAP and SpO2 were significantly higher in the dexmedetomidine group than in the propofol group. CONCLUSION Spinal anesthesia decreased rSO2; however, the decline was not severe. Dexmedetomidine and propofol did not compromise cerebral oxygenation under spinal anesthesia. Nevertheless, MAP and SpO2 were more stable in dexmedetomidine sedation than in propofol sedation. Dexmedetomidine may be suitable for spinal anesthesia.
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Wada K, Masamune T, Ino H, Ueda K, Ishiyama T, Sessler DI, Matsukawa T. Severe hypoglycemia reduces the shivering threshold in rabbits. BMC Anesthesiol 2019; 19:126. [PMID: 31288741 PMCID: PMC6617602 DOI: 10.1186/s12871-019-0794-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background We previously reported that each 100 mg dL− 1 reduction in blood glucose over the range from ≈90 to > 300 mg dL− 1 decreases the shivering threshold (triggering core temperature) in rabbits by 1 °C. However, the effects of lower blood glucose concentrations has yet to be evaluated. We thus evaluated the relationship between the shivering threshold and blood glucose concentration over the mild-to-severe hypoglycemic range. Methods Thirty-nine rabbits were lightly anaesthetized with isoflurane and randomly assigned to one of the three groups: 1) severe hypoglycemia, insulin and dextrose infusions titrated to achieve blood glucose concentration at 45–75 mg dL− 1; 2) mild hypoglycemia, insulin and dextrose infusions titrated to achieve blood glucose concentration at 75–100 mg dL− 1; and 3) saline infusion. Cooling by colonic perfusion of water at 10 °C was continued until shivering occurred or esophageal core temperatures reached to 34 °C. Results The shivering threshold in the severe hypoglycemic rabbits was 35.7 ± 1.1 °C (mean ± SD); the thresholds in the mild hypoglycemic rabbits was 37.0 ± 0.7 °C; and the threshold in the control rabbits was 37.9 ± 1.0 °C. The shivering threshold increased linearly with blood glucose concentration: shivering threshold (°C) = 0.032 ∙ [blood glucose concentration (mg dL− 1)] + 34.1, R2 = 0.45. The shivering threshold thus decreased by approximately 1 °C for each 31 mg dL− 1 decrease in blood glucose concentration. Conclusions There was a linear relationship between blood glucose and the shivering threshold over the range from severe hypoglycemia to normoglycemia. Blood glucose perturbations in the hypoglycemic range reduced the shivering threshold about three times as much as previously reported for the hyperglycemic range.
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Affiliation(s)
- Keiichi Wada
- Surgical Center, University of Yamanashi Hospital, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Taishi Masamune
- Department of Anesthesia, Yamanashi Prefectural Central Hospital, Kofu, Japan
| | - Hirofumi Ino
- Department of Anesthesiology, University of Yamanashi, Chuo, Japan
| | - Kenta Ueda
- Department of Anesthesiology, University of Yamanashi, Chuo, Japan
| | - Tadahiko Ishiyama
- Surgical Center, University of Yamanashi Hospital, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Clinic, Cleveland, USA
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Li HY, Meng JX, Liu Z, Liu XW, Huang YG, Zhao J. Propofol Attenuates Airway Inflammation in a Mast Cell-Dependent Mouse Model of Allergic Asthma by Inhibiting the Toll-like Receptor 4/Reactive Oxygen Species/Nuclear Factor κB Signaling Pathway. Inflammation 2018. [PMID: 29532264 DOI: 10.1007/s10753-018-0746-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Propofol, an intravenous anesthetic agent widely used in clinical practice, is the preferred anesthetic for asthmatic patients. This study was designed to determine the protective effect and underlying mechanisms of propofol on airway inflammation in a mast cell-dependent mouse model of allergic asthma. Mice were sensitized by ovalbumin (OVA) without alum and challenged with OVA three times. Propofol was given intraperitoneally 0.5 h prior to OVA challenge. The inflammatory cell count and production of cytokines in the bronchoalveolar lavage fluid (BALF) were detected. The changes of lung histology and key molecules of the toll-like receptor 4 (TLR4)/reactive oxygen species (ROS)/NF-κB signaling pathway were also measured. The results showed that propofol significantly decreased the number of eosinophils and the levels of IL-4, IL-5, IL-6, IL-13, and TNF-α in BALF. Furthermore, propofol significantly attenuated airway inflammation, as characterized by fewer infiltrating inflammatory cells and decreased mucus production and goblet cell hyperplasia. Meanwhile, the expression of TLR4, and its downstream signaling adaptor molecules--myeloid differentiation factor 88 (MyD88) and NF-κB, were inhibited by propofol. The hydrogen peroxide and methane dicarboxylic aldehyde levels were decreased by propofol, and the superoxide dismutase activity was increased in propofol treatment group. These findings indicate that propofol may attenuate airway inflammation by inhibiting the TLR4/MyD88/ROS/NF-κB signaling pathway in a mast cell-dependent mouse model of allergic asthma.
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Affiliation(s)
- Hong-Yi Li
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Jing-Xia Meng
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Zhen Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Xiao-Wen Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Shijingshan District, Beijing, 100144, China
| | - Yu-Guang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Dongcheng District, Beijing, 100730, China
| | - Jing Zhao
- Department of Anesthesiology, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Chaoyang District, Beijing, 100029, China.
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Effects of hyperventilation on cerebral oxygen saturation estimated using near-infrared spectroscopy: A randomised comparison between propofol and sevoflurane anaesthesia. Eur J Anaesthesiol 2018; 33:929-935. [PMID: 27802250 DOI: 10.1097/eja.0000000000000507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Near-infrared spectroscopy estimates cerebral regional tissue oxygen saturation (rSO2), which may decrease under hyperventilation. Propofol and sevoflurane act differently on cerebral blood vessels. Consequently, cerebral blood flow during hyperventilation with propofol and sevoflurane anaesthesia may differ. OBJECTIVES The first aim of this study was to compare the changes in rSO2 between propofol and sevoflurane anaesthesia during hyperventilation. The second aim was to assess changes in rSO2 with ventilation changes. DESIGN A randomised, open-label study. SETTING University of Yamanashi Hospital, Yamanashi, Japan from January 2014 to September 2014. PARTICIPANTS Fifty American Society of Anesthesiologists physical status 1 or 2 adult patients who were scheduled for elective abdominal surgery were assigned randomly to receive either propofol or sevoflurane anaesthesia. Exclusion criterion was a known history of cerebral disease such as cerebral infarction, cerebral haemorrhage, transient ischaemic attack and subarachnoid haemorrhage. INTERVENTIONS After induction of anaesthesia but before the start of surgery, rSO2, arterial carbon dioxide partial pressure (PaCO2) and arterial oxygen saturation were measured. Measurements were repeated at 5-min intervals during 15 min of hyperventilation with a PaCO2 around 30 mmHg (4 kPa), and again after ventilation was normalised. MAIN OUTCOME MEASURES The primary outcome was the difference of changes in rSO2 between propofol anaesthesia and sevoflurane anaesthesia during and after hyperventilation. The second outcome was change in rSO2 after the initiation of hyperventilation and after the normalisation of ventilation. RESULTS Changes of rSO2 during hyperventilation were -10 ± 7% (left) and -11 ± 8% (right) in the propofol group, and -10 ± 8% (left) and -9 ± 7% (right) in the sevoflurane group. After normalisation of PaCO2, rSO2 returned to baseline values. Arterial oxygen saturation remained stable throughout the measurement period. The rSO2 values were similar in the propofol and the sevoflurane groups at each time point. CONCLUSION The effects of hyperventilation on estimated rSO2 were similar with propofol and sevoflurane anaesthesia. Changes in rSO2 correlated well with ventilation changes. TRIAL REGISTRATION Japan Primary Registries Network (JPRN); UMIN-CTR ID; UMIN000010640.
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Shintani N, Ishiyama T, Kotoda M, Asano N, Sessler DI, Matsukawa T. The effects of Y-27632 on pial microvessels during global brain ischemia and reperfusion in rabbits. BMC Anesthesiol 2017; 17:38. [PMID: 28270098 PMCID: PMC5341179 DOI: 10.1186/s12871-017-0331-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/24/2017] [Indexed: 11/29/2022] Open
Abstract
Background Global brain ischemia-reperfusion during propofol anesthesia provokes persistent cerebral pial constriction. Constriction is likely mediated by Rho-kinase. Cerebral vasoconstriction possibly exacerbates ischemic brain injury. Because Y-27632 is a potent Rho-kinase inhibitor, it should be necessary to evaluate its effects on cerebral pial vessels during ischemia—reperfusion period. We therefore tested the hypotheses that Y-27632 dilates cerebral pial arterioles after the ischemia-reperfusion injury, and evaluated the time-course of cerebral pial arteriolar status after the ischemia-reperfusion. Methods Japanese white rabbits were anesthetized with propofol, and a closed cranial window inserted over the left hemisphere. Global brain ischemia was produced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 min. Rabbits were assigned to cranial window perfusion with: (1) artificial cerebrospinal fluid (Control group, n = 7); (2) topical infusion of Y-27632 10−6 mol · L−1 for 30 min before the initiation of global brain ischemia (Pre group, n = 7); (3) topical infusion of Y-27632 10−6 mol · L−1 starting 30 min before ischemia and continuing throughout the study period (Continuous group, n = 7); and, (4) topical infusion of Y-27632 10−6 mol · L−1 starting 10 min after the ischemia and continuing until the end of the study (Post group, n = 7). Cerebral pial arterial and venule diameters were recorded 30 min before ischemia, just before arterial clamping, 10 min after clamping, and 5, 10, 20, 40, 60, 80, 100, and 120 min after unclamping. Results Mean arterial blood pressure and blood glucose concentration increased significantly after global brain ischemia except in the Continuous group. In the Pre and Continuous groups, topical application of Y-27632 produced dilation of large (mean 18–19%) and small (mean; 25–29%) pial arteries, without apparent effect on venules. Compared with the Control and Pre groups, arterioles were significantly dilated during the reperfusion period in the Continuous and Post groups (mean at 120 min: 5–8% in large arterioles and 11–12% in small arterioles). Conclusions Y-27632 dilated cerebral pial arterioles during reperfusion. Y-27632 may enhance recovery from ischemia by preventing arteriolar vasoconstriction during reperfusion.
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Affiliation(s)
- Noriyuki Shintani
- Surgical Center, University of Yamanashi Hospital, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan.
| | - Tadahiko Ishiyama
- Surgical Center, University of Yamanashi Hospital, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan
| | - Masakazu Kotoda
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan
| | - Nobumasa Asano
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH, USA
| | - Takashi Matsukawa
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Yamanashi, Japan
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Ino H, Masamune T, Sato H, Okuyama K, Wada K, Iwashita H, Ishiyama T, Oguchi T, Sessler DI, Matsukawa T. The Effects of Blood Glucose Concentration on the Shivering Threshold in Rabbits. Anesth Analg 2015; 121:525-31. [DOI: 10.1213/ane.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Effects of topical and intravenous JM-1232(-) infusion on cerebrovascular reactivity in rats. J Anesth 2015; 29:798-802. [PMID: 25913256 DOI: 10.1007/s00540-015-2017-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
A novel short-acting benzodiazepine receptor agonist, JM-1232(-), has been shown to have a sedative/hypnotic effect and wide safety margin. However, its effect on cerebral vessels is not well known. Therefore, we investigated the cerebrovascular reactivity to topical and intravenous JM-1232(-) and during hypotension or hypercapnia with intravenous administration of JM-1232(-). We used a closed cranial window preparation to measure the changes of cerebral pial arteriolar diameters in isoflurane-anesthetized Sprague-Dawley rats. We first measured the direct effect of topical JM-1232(-). We then determined the effect of intravenous JM-1232(-) and then we measured the response to hypercapnia before and after JM-1232(-) infusion. Finally, we measured the reaction to stepwise induction of hypotension before and after JM-1232(-) infusion. Topical infusion of JM-1232(-) dilated pial arterioles. Intravenous infusion of JM-1232(-) changed pial arterioles by 4.5 ± 2.7 %, 5.0 ± 3.9 %, and -2.8 ± 2.6 % (at 0.1, 0.3, and 1.0 mg/kg/min, respectively). Hypercapnia dilated pial arterioles before and after JM-1232(-) infusion. The diameters of pial arterioles did not change during hypotension before or after intravenous JM-1232(-) infusion. These results indicate that topical JM-1232(-) has a dilative effect on pial arterioles and that intravenous administration of JM-1232(-) may not affect cerebrovascular reactivity to hypotension or hypercapnia.
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Ikemoto K, Ishiyama T, Shintani N, Asano N, Sessler DI, Matsukawa T. The effects of topical and intravenous JM-1232(-) on cerebral pial microvessels of rabbits. BMC Anesthesiol 2015; 15:37. [PMID: 25805961 PMCID: PMC4372327 DOI: 10.1186/s12871-015-0016-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/24/2015] [Indexed: 11/30/2022] Open
Abstract
Background JM-1232(-) is a novel anesthetic agent which acts through gamma-aminobutyric acid receptors. Cerebral pial vascular effects of JM-1232(-) are unknown. We thus evaluated topical and intravenous effects of JM-1232(-) on cerebral pial microvessels in rabbits, and the extent to which carbon dioxide (CO2) reactivity is preserved. Methods Closed cranial windows were used to visualize cerebral pial circulation in 29 Japanese white rabbits. In the first experiment, the cranial window was superfused with increasing concentrations of JM-1232(-): 10-11, 10-9, 10-7, 10-5 mol/L, n = 8 per concentration. In the second experiment, we examined the effects of an intravenous bolus of 1 mg/kg bolus of JM-1232(-), followed by the continuous infusion at 0.3 mg/kg/minute on cerebral pial vascular alteration (n = 9). In the third, we examined CO2 reactivity of cerebral pial vessels under JM-1232(-) (n = 6) or sevoflurane anesthesia (n = 6). Results Topical application of JM-1232(-) did not change pial venular diameter, and constricted arterials only at the highest concentration. Intravenous administration of JM-1232(-) produced cerebral pial constriction which gradually diminished over time. Under intravenous administration of JM-1232(-) and inhaled sevoflurane, diameters of vessels increased in parallel with CO2 partial pressure. Slopes of linear regression and correlation coefficients in arterioles and venules were comparable for JM-1232(-) anesthesia and sevoflurane anesthesia. Conclusions Topical application of JM-1232(-) had little effect on cerebral pial vessels. Intravenous administration produced vasoconstriction of cerebral pial arterioles and venules, however those changes were clinically unimportant. In addition, JM-1232(-) did not impair CO2 responsiveness. At least from the perspective of vascular reactivity, JM-1232(-) thus appears safe for neurosurgical patients.
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Affiliation(s)
- Kodai Ikemoto
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3898 Japan
| | - Tadahiko Ishiyama
- Surgical Center, University of Yamanashi Hospital, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3898 Japan
| | - Noriyuki Shintani
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3898 Japan
| | - Nobumasa Asano
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3898 Japan
| | - Daniel I Sessler
- Department of Outcomes Research, The Cleveland Clinic, Ohio, USA
| | - Takashi Matsukawa
- Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo Yamanashi, 409-3898 Japan
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Terada Y, Ishiyama T, Asano N, Kotoda M, Ikemoto K, Shintani N, Sessler DI, Matsukawa T. Optimal doses of sevoflurane and propofol in rabbits. BMC Res Notes 2014; 7:820. [PMID: 25409660 PMCID: PMC4289294 DOI: 10.1186/1756-0500-7-820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 11/06/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although sevoflurane and propofol are commonly used anesthetics in rabbits, optimal doses of remain unclear. We thus assessed the optimal hypnotic doses of sevoflurane and propofol, and evaluated the influence of dexmedetomidine on sevoflurane and propofol requirements. METHODS Twenty-eight Japanese white rabbits were randomly assigned to one of four groups (n=7 each). Rabbits were given either sevoflurane, propofol, sevoflurane+dexmedetomidine, or propofol+dexmedetomidine (injected 30 μg∙kg(-1)∙hr(-1) for 10 min followed by an infusion of 3.5 μg∙kg(-1)∙hr(-1)). Hypnotic level was evaluated with Bispectral Index (BIS), a well-validated electroenchalographic measure, with values between 40 and 60 representing optimal hypnosis. BIS measurements were made 10 minutes after the adjustment of target end-tidal sevoflurane concentration in the sevoflurane group and sevoflurane+dexmedetomidine group, and at 10 min after the change of infusion rate in the propofol group and propofol+dexmedetomidine group. RESULTS BIS values were linearly related to sevoflurane concentration and propofol infusion rate, with or without dexmedetomidine. Sevoflurane concentration at BIS=50 was 3.9±0.2% in the sevoflurane group and 2.6±0.3% in the sevoflurane+dexmedetomidine group. The propofol infusion rate to make BIS=50 was 102±5 mg∙kg(-1)∙hr(-1) in the propofol group, and 90±10 mg∙kg(-1)∙hr(-1) in the propofol+dexmedetomidine group. CONCLUSIONS The optimal end-tidal concentration of sevoflurane alone was thus 3.9%, and optimal infusion rate for propofol alone was 102 mg∙kg(-1)∙hr(-1). Dexmedetomidine reduced sevoflurane requirement by 33% and propofol requirement by 11%.
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Affiliation(s)
| | - Tadahiko Ishiyama
- Surgical Center, University of Yamanashi Hospital, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
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Ishiyama T, Kotoda M, Asano N, Ikemoto K, Mitsui K, Sato H, Matsukawa T, Sessler DI. The effects of Patent Blue dye on peripheral and cerebral oxyhaemoglobin saturations. Anaesthesia 2014; 70:429-33. [DOI: 10.1111/anae.12932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
- T. Ishiyama
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - M. Kotoda
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - N. Asano
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - K. Ikemoto
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - K. Mitsui
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - H. Sato
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - T. Matsukawa
- Department of Anesthesiology; Faculty of Medicine; University of Yamanashi; Chuo Yamanashi Japan
| | - D. I. Sessler
- Department of Outcomes Research; Anesthesiology Institute; The Cleveland Clinic; Cleveland OH USA
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Ye HH, Wu KJ, Fei SJ, Zhang XW, Liu HX, Zhang JL, Zhang YM. Propofol participates in gastric mucosal protection through inhibiting the toll-like receptor-4/nuclear factor kappa-B signaling pathway. Clin Res Hepatol Gastroenterol 2013; 37:e3-15. [PMID: 22516481 DOI: 10.1016/j.clinre.2012.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 02/20/2012] [Accepted: 03/02/2012] [Indexed: 02/04/2023]
Abstract
AIMS Propofol has demonstrated protective effects against digestive injury. Toll-like receptor-4 (TLR4) is involved in gastric mucosal injury. However, it has not yet been clarified whether propofol protects gastric mucosa from ethanol-induced injury and whether the mechanism involved is related to TLR4 activation. Therefore, this prospective study was carried out to address the issue. METHODS Gastric mucosal injury was induced in mice by intragastric administration of ethanol. Propofol was given intraperitoneally 30 min before ethanol intragastric administration and, 1h later, gastric specimens were studied using hematoxylin--eosin staining, quantitative real-time RT-PCR, immunohistochemical staining and Western blot assays; serum specimens were studied using ELISA kits. RESULTS Propofol at 25mg/kg significantly attenuated ethanol-induced gastric mucosal injury. In addition, propofol pretreatment significantly inhibited the upregulated expression of high-mobility group box-1 (HMGB1) protein, TLR4 and its downstream signaling molecules--myeloid differentiation factor 88 (MyD88) and nuclear factor kappa-B (NF-κB)--in gastric mucosa, while suppressing the increased release of tumor neurosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum. Furthermore, upregulation of the Bax/Bcl-2 ratio in gastric mucosa was clearly depressed by propofol. CONCLUSION Propofol can inhibit HMGB1 expression and TLR4/MyD88/NF-κB-mediated inflammatory responses, and hamper apoptosis, which may contribute to its protective action against ethanol-induced gastric mucosal injury.
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Affiliation(s)
- Hui-Hui Ye
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, 84, West Huaihai Road, Jiangsu Province 221002, Xuzhou, China
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Klein K, Fukui K, Schramm P, Stadie A, Fischer G, Werner C, Oertel J, Engelhard K. Human cerebral microcirculation and oxygen saturation during propofol-induced reduction of bispectral index †. Br J Anaesth 2011; 107:735-41. [DOI: 10.1093/bja/aer227] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cerebral pial vascular changes under propofol or sevoflurane anesthesia during global cerebral ischemia and reperfusion in rabbits. J Neurosurg Anesthesiol 2010; 22:207-13. [PMID: 20118796 DOI: 10.1097/ana.0b013e3181cd318b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Propofol and sevoflurane are commonly used anesthetics for neurosurgery. The aim of the study was to compare the effects of propofol with sevoflurane on cerebral pial arteriolar and venular diameters during global brain ischemia and reperfusion. METHODS Japanese white rabbits were anesthetized with propofol (n=11), sevoflurane (n=9), or the combination of sevoflurane and intralipid (n=10). Global brain ischemia was induced by clamping the brachiocephalic, left common carotid, and left subclavian arteries for 15 minutes. Pial microcirculation was observed microscopically through closed cranial windows and measured using a digital-video analyzer. Measurements were recorded before clamping and afterward for 120 minutes. RESULTS Plasma glucose and mean arterial blood pressure increased significantly during ischemia in the propofol-anesthetized rabbits. During ischemia, pial arteriolar and venular diameters decreased significantly in all groups. After unclamping, large and small, pial arteriolar and venular diameters increased temporarily and significant dilation was observed in both sevoflurane groups. From 10 minutes after unclamping until the end of the study, large and small arterioles returned to baseline diameters in the sevoflurane groups, but decreased significantly by 10% to 20% in the propofol rabbits. Ischemia-induced adverse effects such as pulmonary edema and acute brain swelling were observed primarily in propofol-anesthetized rabbits. CONCLUSION Propofol and sevoflurane acted differently on pial vessels during reperfusion after ischemic insult. Pial arterioles and venules did not dilate immediately after reperfusion, and subsequently constricted throughout the reperfusion period in propofol-anesthetized rabbits. In contrast, pial arterioles and venules dilated temporarily and returned to baseline in sevoflurane-anesthetized rabbits.
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Intraoperative monitoring of cerebral microcirculation and oxygenation--a feasibility study using a novel photo-spectrometric laser-Doppler flowmetry. J Neurosurg Anesthesiol 2010; 22:38-45. [PMID: 19816204 DOI: 10.1097/ana.0b013e3181bea439] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The present study assesses the utility of a novel invasive device (O2C-, oxygen-to-see-device) for intraoperative measurement of the cerebral microcirculation. CO2 vasoreactivity during 2 different propofol concentrations was used to investigate changes of capillary venous cerebral blood flow (rvCBF), oxygen saturation (srvO2), and hemoglobin concentration (rvHb) during craniotomy. METHODS Thirty-four patients were randomly assigned to a low propofol (4 mg/kg/h) versus a high propofol (6 mg/kg/h) group. A fiberoptic probe was applied on the cortex next to the surgical site. Measurements were performed during lower (35 mm Hg) and higher (45 mm Hg) levels of partial pressure of carbon dioxide (paCO2). Arterio-venous difference in oxygen concentration (avDO2) and approximated cerebral metabolic rate of oxygen (aCMRO2) were calculated for each paCO2 state. Linear models were fitted to test changes of end points in response to paCO2 and propofol concentration. RESULTS In comparison to the lower levels of paCO2, higher levels of paCO2 increased rvCBF (P<0.001), and srvO2 (P=0.002). RvHb remained unchanged during measurements (P=0.325). Calculated avDO2 decreased with increasing paCO2 (P<0.001), whereas aCMRO2 did not change during the study (P=0.999). Propofol concentration had no effect on measured or calculated end points. CONCLUSIONS Increase of rvCBF by paCO2 indicates a preserved CO2 reactivity independent of propofol anesthesia. The consecutive rise in srvO2 implies enhanced oxygen availability due to vasodilatation. Unchanged rvHb represents constant venous hemoglobin concentration. As expected, calculated avDO2 decreases with increased paCO2, whereas aCMRO2 remains unchanged. Despite the promising technical approach, the technology needs validation and further investigation for usage during neurosurgery.
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Masamune T, Sato H, Okuyama K, Imai Y, Iwashita H, Ishiyama T, Oguchi T, Sessler DI, Matsukawa T. The Shivering Threshold in Rabbits with JM-1232(−), a New Benzodiazepine Receptor Agonist. Anesth Analg 2009; 109:96-100. [DOI: 10.1213/ane.0b013e3181a1a5ed] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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