Clinical evaluation of constant rate infusion of alfaxalone-medetomidine combined with sevoflurane anesthesia in Thoroughbred racehorses undergoing arthroscopic surgery

Recovery of horses from general anaesthesia: A systematic review (2000-2020) of the influence of anaesthetic protocol on recovery quality

BACKGROUND

The recovery phase after equine general anaesthesia (GA) is a time of considerable risk and therefore has been the subject of extensive research over the last 20 years. Various pharmacological interventions have been developed and studied with the objective of improving recovery quality and reducing anaesthetic-related mortality and morbidity. Nevertheless, some controversy remains regarding the influence of anaesthetic protocol choice on recovery quality from GA and its implications for recovery-related mortality and morbidity. A systematic review of the literature investigating the influence of anaesthetic protocol choice on recovery quality is currently lacking.

OBJECTIVES

To perform a detailed evaluation of the equine veterinary literature investigating the effect of anaesthetic protocol choice on equine recovery quality utilising the GRADE framework.

STUDY DESIGN

A systematic evaluation of the equine veterinary literature was performed using the GRADE framework.

METHODS

A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub-topic was assessed using the GRADE framework.

RESULTS

A total of 124 studies were identified which directly assessed the impact of anaesthetic protocol choice on recovery quality after GA in horses. Evaluation of the available evidence indicated that certain partial intravenous anaesthesia (PIVA) agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.

MAIN LIMITATIONS

The validity of the results of some studies may have been compromised by missing data and small sample sizes.

CONCLUSIONS

There is evidence to indicate that certain PIVA agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

Simple Summary

Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions.

Abstract

Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.

Sevoflurane regulates migration and invasion of colorectal cancer cells by up-regulating miR-34a

AIM

To investigate the effect of sevoflurane on the migration and invasion of human colorectal cancer HCT116 cells, and to explore the underlying molecular mechanism.

METHODS

The effect of sevoflurane on the proliferation of HCT116 cells was examined by CCK-8 assay. Real-time quantitative PCR was used to detect the expression of miR-34a in cells. Transwell assay was used to detect cell migration and invasion. Western blot was used to detect the expression levels of MMP-2 and MMP-9 in cells.

RESULTS

The concentration of action of sevoflurane was determined to be 4% by CCK-8 assay. The expression of miR-34a increased by 79% after treatment of HCT116 cells with 4% sevoflurane for 4 h. After transfection with miR-34a inhibitor, the expression level of miR-34a in cells decreased by 81%. After sevoflurane intervention, the number of migrated cells decreased from 97.75 ± 16.10 to 36.60 ± 8.58, the number of invasive cells decreased from 64.22 ± 6.25 to 26.48 ± 3.10, the expression level of MMP-2 protein was down-regulated from 0.68 ± 0.11 to 0.24 ± 0.04, and the expression level of MMP-9 protein was down-regulated from 0.48 ± 0.07 to 0.13 ± 0.02. After inhibiting the expression of miR-34a, the number of migrated cells was increased from 40.15 ± 9.02 to 88.65 ± 12.74, the number of invasive cells increased from 26.12 ± 3.02 to 59.24 ± 4.68, the expression level of MMP-2 protein was up-regulated from 0.22 ± 0.03 to 0.61 ± 0.09, and the expression level of MMP-9 protein was up-regulated from 0.14 ± 0.03 to 0.43 ± 0.06.

CONCLUSION

Sevoflurane inhibits the migration and invasion of human colorectal cancer HCT116 cells by up-regulating the expression of miR-34a, which may be related to the inhibition of MMP-2 and MMP-9 protein expression.