Propofol modulates inner retina function in Beagles

Repeated measurements of ERGs and VEPs using chloral hydrate sedation and propofol anesthesia in young children

PURPOSE

Sedation with chloral hydrate or anesthesia using propofol allow ocular examination and testing in young children, but these drugs may affect electrophysiologic recordings. We compared the flash and pattern ERGs and VEPs recorded with each drug in a cohort of young children enrolled in a prospective study of optic nerve hypoplasia (ONH) syndrome.

METHODS

ERGs and VEPs to light-adapted, standard, full-field flashes, to standard and steady-state pattern-reversal (PR) were recorded with cycloplegia in 9 participants. Age range at the first session, with chloral hydrate was 8-23 mo; at the second session with propofol it was 20-29 mo. Examiners masked to the drug and clinical conditions measured the waveforms for longitudinal, paired comparisons between the sessions.

RESULTS

Flash ERG amplitudes did not differ between sessions; peak times were longer at the second session (propofol) by clinically insignificant amounts (< 2 ms, p = 0.002). Standard PERGs had larger amplitudes and later peaks in the second session (propofol) than with chloral hydrate (P50 2.9 vs 4.7 μV, p = 0.016 and 43 vs 52 ms, p < 0.001; N95 4.0 vs 6.1 μV, p = 0.003 and 91 vs 98.5 ms p = 0.034.). These differences were present for those with an interval of  > 10 mo between sessions (n = 5, 10 eyes) but not for those with a shorter inter-test interval (< 8 mo, p > 0.05, n = 4). Magnitudes of the steady-state PERGs did not differ between tests but the waveforms had earlier peaks at the second test with propofol. Flash VEP waveforms were present in 10/18 eyes and showed 72% agreement for recordability between sessions. Standard pattern VEPs were recordable in only a few eyes in this cohort with ONH.

CONCLUSIONS

Light-adapted flash ERG waveforms were generally similar with chloral hydrate and with propofol. Larger PERGs with later peaks, found in the second session (propofol) could reflect maturation of the PERG generators, as the differences found were associated with a greater age difference between the sessions, but we do not rule out that small differences in the waveforms may be drug-related. There are insufficient VEP data from these children with ONH to identify drug-related or maturational effects on VEPs.

Effect of Three Different Sedatives on Electroretinography Recordings in Domestic Pigeons (Columba livia)

This study was conducted to compare the effects of 3 different sedative agents on electroretinography (ERG) in domestic pigeons (Columba livia). Six pigeons were sedated with alfaxalone, xylazine, and medetomidine at separate times with a 1-week washout period between sedative administration. After sedation with each agent, pigeons underwent the modified ERG protocol adapted from the standardized protocol for dogs. The scotopic mixed rod and cone response was recorded after 20 minutes of dark adaptation, and the photopic cone response and photopic flicker response were recorded after 10 minutes of light adaptation. Either a 1-way analysis of variance or a Kruskall-Wallis test was used to compare the a-wave and b-wave implicit time and amplitude. No significant differences were observed in the scotopic mixed rod and cone response among all 3 sedatives used. Compared with alfaxalone, medetomidine significantly prolonged the a-wave implicit time, depressed the b-wave amplitude of photopic cone response, and prolonged the peak implicit time of the photopic flicker response (P < .05). These results show that medetomidine has a depressant effect on photopic ERG in pigeons at a dosage that produces light sedation.

Subretinal surgery: functional and histological consequences of entry into the subretinal space

BACKGROUND AND OBJECTIVES

Gene-therapy, stem-cell transplantation and surgical robots hold the potential for treatment of currently untreatable retinal degenerative diseases. All of the techniques require entry into the subretinal space, which is a potential space located between the retina and the retinal pigment epithelium (RPE). Knowledge about obstacles and critical steps in relation to subretinal procedures is therefore needed. This thesis explores the functional and histological consequences of separation of the retina from the RPE, extensive RPE damage, a large cut in the retina (retinotomy) and RPE phagocytosis in a porcine model.

METHODS

Experiments were performed in 106 female domestic pigs of Danish landrace distributed over five studies. Under general anesthesia, different procedures for expansion of the subretinal space were conducted. Outcomes were visual function measured electrophysiologically with multifocal electroretinogram (mfERG) and retinal morphology examined histologically. Study I: The effect of anesthesia on mfERG was examined by repeated recordings for 3 hr in isoflurane or propofol anesthesia. Outcome was mfERG amplitude. Study II: Consequences of a large separation of the photoreceptors from the RPE were examined by injecting a perfluorocarbon-liquid (decalin) into the subretinal space. Two weeks after, in a second surgery, decalin was withdrawn. Outcomes were mfERG and histology 4 weeks after decalin injection. Study III: Extensive RPE damage was examined by expanding the subretinal space with saline and removing large sheets of RPE-cells through a retinotomy. Outcomes were mfERG and histology 2, 4 and 6 weeks after the procedure. Study IV: Consequences of a large retinotomy were examined by similar procedures as in Study III, but in study IV only a few RPE cells were removed. Outcomes were mfERG and histology 2 and 6 weeks after surgery. Study V: Clearance of the subretinal space was examined by injecting fluorescent latex beads of various sizes into the subretinal space. Outcome was histologic location of the beads at different time intervals after the procedure.

RESULTS

Study I: MfERG amplitudes decreased linearly as a function of time in propofol or isoflurane anesthesia. Duration of mfERG recording could be decreased without compromising quality, and thereby could time in anesthesia be reduced. Study II: MfERG and histology remained normal after reattachment of a large and 2-week long separation of the photoreceptors and RPE. Repeated entry into the subretinal space was well tolerated. Fluid injection into the subretinal space constitutes a risk of RPE-damage. Study III: Removal of large sheets of retinal pigment epithelial cells triggered a widespread rhegmatogenous-like retinal detachment resulting in visual loss. Study IV: A large retinotomy with limited damage of the RPE was well tolerated, and visual function was preserved. Study V: Subretinal latex beads up to 4 μm were phagocytosed by the RPE and passed into the sub-RPE space. Beads up to 2 μm travelled further through the Bruch's membrane and were found in the choroid, sclera and inside blood vessels.

CONCLUSION

A large expansion of the subretinal space, repeated entry, a large retinotomy and limited RPE damage is well tolerated and retinal function is preserved. Subretinal injection of fluid can damage the RPE and extensive RPE damage can induce a rhegmatogenous-like retinal detachment with loss of visual function. Foreign substances exit the subretinal space and can reach the systemic circulation.

Normal clinical electroretinography parameters for poodle, Labrador retriever, Thai ridgeback, and Thai Bangkaew

The purpose of the present study was to establish normal electroretinogram (ERG) parameters using 56 normal eyes of four dog breeds common in Thailand: poodle, Labrador retriever, Thai ridgeback, and Thai Bangkaew. Standard ERG findings were bilaterally recorded using a handheld multi-species ERG unit with an ERG-jet lens electrode for 28 dogs under preanesthesia with diazepam, anesthesia with propofol, and anesthesia maintenance with isoflurane. There were significant differences in the mean values of ERG amplitudes and implicit times among the four dog breeds (p < 0.05) except for the b-wave implicit time of the photopic 30 Hz flicker response with 3 cd.s/m(2) (p = 0.610). Out of the four breeds, Thai Bangkaew had the longest implicit time (p < 0.001) of scotopic low intensity responses, b-wave of scotopic standard intensity responses (3 cd.s/m(2)), a-wave of the higher intensity response (10 cd.s/m(2)), and a-wave of the photopic single flash response (3 cd.s/m(2)). For the b/a ratio, only the ratio of the Cone response was significantly different among the different breeds. In this summary, normal ERG parameters for four dog breeds were reported. Data from the investigation supported the hypothesis that determination of breed-specific limits of normality for ERG responses is necessary for individual clinics and laboratories.

Effects of chemical restraint on electroretinograms recorded sequentially in awake, sedated, and anesthetized dogs

OBJECTIVE

To quantitatively and qualitatively compare electroretinography (ERG) recordings in awake, sedated, and anesthetized dogs.

ANIMALS

Six 6-month-old Beagles.

PROCEDURES

A brief ERG protocol for dogs was used. Following 1-minute and subsequent 5-minute dark adaptation, mixed rod-cone responses were recorded bilaterally with a handheld multispecies ERG device with dogs in each of 3 states of consciousness: awake, sedated (dexmedetomidine and butorphanol), and anesthetized (atropine and hydromorphone, followed by propofol and midazolam and anesthetic maintenance with isoflurane). Low- and high-frequency noise levels were quantified via Fourier analysis, and the effect of consciousness state on signal amplitude, implicit time, and noise was analyzed via repeated-measures ANOVA. In addition, 13 veterinary ophthalmologists who were unaware of the dogs' consciousness states subjectively graded the ERG recording quality, and scores for each tracing were compared.

RESULTS

ERG amplitudes were highest in awake dogs and lowest in anesthetized dogs. Implicit times were shortest in awake dogs and longest in anesthetized dogs. Differences in b-wave amplitudes and a-wave implicit times were significant. Neither low- nor high-frequency noise levels differed significantly among consciousness states. Furthermore, no significant differences were identified among observers' scores assigned to ERG tracings.

CONCLUSIONS AND CLINICAL RELEVANCE

Anesthesia and sedation resulted in significant attenuation and delay of ERG responses in dogs. Chemical restraint of dogs had no consistently significant effect on low- or high-frequency noise levels or on observer perception of signal quality.

The effect of pentobarbital sodium and propofol anesthesia on multifocal electroretinograms in rhesus macaques

We compared the suitability of pentobarbital sodium (PB) and propofol (PF) anesthetics for multifocal electroretinograms (mfERGs) in rhesus macaques. mfERGs were collected from 4 ocularly normal rhesus macaques. All animals were pre-anesthetized with intramuscular ketamine (10-15 mg/kg). Intravenous PB induction/maintenance levels were 15 mg/kg/2-10 mg/kg and for PF, 2-5 mg/kg/6-24 mg/kg/h. There were 3 testing sessions with PB anesthesia and 5-7 testing sessions with PF anesthesia. All PB sessions were carried out before PF. First-order (K1) and second-order (first slice) kernels (K2.1) response density amplitude (RDA), implicit time (IT), and root mean square signal-to-noise ratios (RMS SNR) of the low-frequency (LFC) and high-frequency (HFC) components were evaluated. The use of PF or PB anesthesia resulted in robust, replicable mfERGs in rhesus macaques; however, RMS SNR of K1 LFC in ring and quadrant analyses was significantly larger for PF than for PB. Additionally, K1 RDA under PF was significantly larger than under PB for N1, P1, and P2 components (ring and quadrant) and for N2 (quadrant). PF IT was significantly prolonged (<1 ms) relative to PB IT for N1, P1 (ring), and N1 (quadrant), while PB IT was significantly prolonged (0.8-4.2 ms) relative to PF IT for N2 and P2 (ring and quadrant). K1 HFC and K2.1 LFC did not differ significantly between PB and PF in the ring or quadrant analyses. The response differences found with PB and PF anesthesia likely arise from variable relative effects of the anesthetics on retinal γ-aminobutyric acid (GABA(A)) receptors, and in part, on glycine and on glutamate receptors. Given the advantages of a stable anesthetic plane with continuous intravenous infusion and a smoother, more rapid recovery, PF is an appealing alternative for mfERG testing in rhesus macaques.

Potentiating action of propofol at GABAA receptors of retinal bipolar cells

PURPOSE

Propofol (2,6-diisopropyl phenol), a widely used systemic anesthetic, is known to potentiate GABA(A) receptor activity in a number of CNS neurons and to produce changes in electroretinographically recorded responses of the retina. However, little is known about propofol's effects on specific retinal neurons. The authors investigated the action of propofol on GABA-elicited membrane current responses of retinal bipolar cells, which have both GABA(A) and GABA(C) receptors.

METHODS

Single, enzymatically dissociated bipolar cells obtained from rat retina were treated with propofol delivered by brief application in combination with GABA or other pharmacologic agents or as a component of the superfusing medium.

RESULTS

When applied with GABA at subsaturating concentrations and with TPMPA (a known GABA(C) antagonist), propofol markedly increased the peak amplitude and altered the kinetics of the response. Propofol increased the response elicited by THIP (a GABA(A)-selective agonist), and the response was reduced by bicuculline (a GABA(A) antagonist). The response to 5-methyl I4AA, a GABA(C)-selective agonist, was not enhanced by propofol. Serial brief applications of (GABA + TPMPA + propofol) led to a progressive increase in peak response amplitude and, at higher propofol concentrations, additional changes that included a prolonged time course of response recovery. Pre-exposure of the cell to perfusing propofol typically enhanced the rate of development of potentiation produced by (GABA + TPMPA + propofol) applications.

CONCLUSIONS

Propofol exerts a marked and selective potentiation on GABA(A) receptors of retinal bipolar cells. The data encourage the use of propofol in future studies of bipolar cell function.

The 'dark' side of sedation: 12 years of office-based pediatric deep sedation for electroretinography in the dark

OBJECTIVES

Analyze pediatric ERG data for adverse events, interventions, and outcomes of propofol sedations performed in near-complete darkness.

AIM

To demonstrate that deep sedation with propofol for ERG can be performed efficiently and safely in children in near-total darkness.

BACKGROUND

Full-field electroretinography (ERG) is a valuable tool for the diagnosis of vision loss in children. The ERG measures the electrical activity of the retina. In children, ERG quality significantly improves with deep sedation by allowing easier eye electrode placement and decreasing motion artifacts. As this procedure must be performed in darkness, administering sedation imposes unique challenges.

METHODS AND MATERIALS

ERGs are performed outside of the operating room in our hospital's electrophysiology suite. IVs are placed, and patients are allowed to adapt to complete darkness. An anesthesiologist then administers propofol sedation in the dark with the aid of a red-filter light source and monitor light shields. Data were collected on 379 patients (411 ERGs) performed from 1996 to 2008. These records were reviewed and analyzed for demographic, medical, and anesthetic data.

RESULTS

Propofol sedation resulted in an ERG completion rate of 99.5%. During sedation, 8.5% (35) of patients experienced minor respiratory complications such as airway obstruction that resulted in an oxygen saturation <90%. A total of 9.7% (40) of patients required minor airway interventions such as a chin lift.

CONCLUSIONS

We demonstrated that pediatric sedation is a safe, efficient, and a cost-effective method for measuring ERGs in a challenging environment. The incidence of minor complications is low and appears similar to other studies of propofol sedation.

Multifocal electroretinographical changes in monkeys with experimental ocular hypertension: a longitudinal study

PURPOSE

To study the time course of changes in the multifocal electroretinograms (mfERG) in monkeys with experimental ocular hypertension (OHT).

METHODS

The mfERGs were recorded in 12 eyes out of 6 monkeys. Two baseline measurements were used to quantify the reproducibility, the inter-ocular and the inter-individual variability of the ERG signals. Thereafter, the trabeculum of one eye of each animal was laser-coagulated in one to three sessions to induce OHT. ERG measurements were repeated regularly in a period of 18 months and the changes in ERG waveforms were quantified.

RESULTS

All animals displayed OHT (between 20 and 50 mmHg) in the laser-coagulated eyes. An ERG change was defined as the sum of differences during the first 90 ms between the laser-coagulated eye and the same eye before laser coagulation and between the laser-coagulated eye and the non-treated fellow eye. Three animals displayed significant changes for nearly all retinal areas and all stimulus conditions. The three remaining animals displayed significant changes only in one comparison, indicating very mild changes. The data indicate that a high stimulus contrast is more sensitive to detect changes, probably because of a better signal-to-noise ratio. Moreover, the comparisons with the fellow eye are more sensitive to detect changes than comparisons with the measurements before laser-coagulation.

CONCLUSIONS

OHT does not always lead to ERG changes. Comparisons with fellow eyes using high contrast stimuli are more sensitive to detect changes related to OHT.