1
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McGinnity CJ, Årstad E, Beck K, Brooks DJ, Coles JP, Duncan JS, Galovic M, Hinz R, Hirani E, Howes OD, Jones PA, Koepp MJ, Luo F, Riaño Barros DA, Singh N, Trigg W, Hammers A. Comment on " In Vivo [ 18F]GE-179 Brain Signal Does Not Show NMDA-Specific Modulation with Drug Challenges in Rodents and Nonhuman Primates". ACS Chem Neurosci 2019; 10:768-772. [PMID: 30346706 DOI: 10.1021/acschemneuro.8b00246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Schoenberger and colleagues ( Schoenberger et al. ( 2018 ) ACS Chem. Neurosci. 9 , 298 - 305 ) recently reported attempts to demonstrate specific binding of the positron emission tomography (PET) radiotracer, [18F]GE-179, to NMDA receptors in both rats and Rhesus macaques. GE-179 did not work as expected in animal models; however, we disagree with the authors' conclusion that "the [18F]GE-179 signal seems to be largely nonspecific". It is extremely challenging to demonstrate specific binding for the use-dependent NMDA receptor intrachannel ligands such as [18F]GE-179 in animals via traditional blocking, due to its low availability of target sites ( Bmax'). Schoenberger and colleagues anesthetized rats and Rhesus monkeys using isoflurane, which has an inhibitory effect on NMDA receptor function and thus would be expected to further reduce the Bmax'. The extent of glutamate release achieved in the provocation experiments is uncertain, as is whether a significant increase in NMDA receptor channel opening can be expected under anesthesia. Prior data suggest that the uptake of disubstituted arylguanidine-based ligands such as GE-179 can be reduced by phencyclidine binding site antagonists, if injection is performed in the absence of ketamine and isoflurane anesthesia, e.g., with GE-179's antecedent, CNS 5161 ( Biegon et al. ( 2007 ) Synapse 61 , 577 - 586 ), and with GMOM ( van der Doef et al. ( 2016 ) J. Cereb. Blood Flow Metab. 36 , 1111 - 1121 ). However, the extent of nonspecific uptake remains uncertain.
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Affiliation(s)
- Colm J. McGinnity
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- King’s
College London & Guy’s and St Thomas’ PET Centre,
St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Erik Årstad
- Institute of Nuclear Medicine and Department of Chemistry, University College London, London NW1 2BU, United Kingdom
| | - Katherine Beck
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | - David J. Brooks
- Department of Nuclear Medicine, Aarhus University, Aarhus 8200, Denmark
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE1 7RU, United Kingdom
| | - Jonathan P. Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - John S. Duncan
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
| | - Marian Galovic
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
- Department of Neurology, Kantonsspital St Gallen, 9007 St. Gallen, Switzerland
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester M20 3LJ, United Kingdom
| | - Ella Hirani
- GE Healthcare Ltd, Amersham HP7 9LL, United Kingdom
| | - Oliver D. Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | | | - Matthias J. Koepp
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, United Kingdom
- Epilepsy Society, Gerrards Cross SL9 0RJ, United Kingdom
| | - Feng Luo
- GE Healthcare Ltd, Amersham HP7 9LL, United Kingdom
| | - Daniela A. Riaño Barros
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, London BR3 3BX, United Kingdom
| | - Nisha Singh
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, United Kingdom
| | | | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, United Kingdom
- King’s
College London & Guy’s and St Thomas’ PET Centre,
St Thomas’ Hospital, London SE1 7EH, United Kingdom
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2
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Bajwa NM, Lee JB, Halavi S, Hartman RE, Obenaus A. Repeated isoflurane in adult male mice leads to acute and persistent motor decrements with long-term modifications in corpus callosum microstructural integrity. J Neurosci Res 2018; 97:332-345. [DOI: 10.1002/jnr.24343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Nikita M. Bajwa
- Musculoskeletal Disease Center; VA Loma Linda Healthcare System; Loma Linda California
| | - Jeong B. Lee
- Department of Basic Sciences, School of Medicine; Loma Linda University; Loma Linda California
| | - Shina Halavi
- Department of Psychology, School of Behavioral Health; Loma Linda University; Loma Linda California
| | - Richard E. Hartman
- Department of Psychology, School of Behavioral Health; Loma Linda University; Loma Linda California
| | - Andre Obenaus
- Department of Basic Sciences, School of Medicine; Loma Linda University; Loma Linda California
- Department of Pediatrics, School of Medicine; University of California; Irvine California
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3
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Sheppard AM, Zhao DL, Salvi R. Isoflurane anesthesia suppresses distortion product otoacoustic emissions in rats. J Otol 2018; 13:59-64. [PMID: 30559766 PMCID: PMC6291629 DOI: 10.1016/j.joto.2018.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 02/01/2023] Open
Abstract
A commonly used anesthetic, isoflurane, can impair auditory function in a dose-dependent manner. However, in rats, isoflurane-induced auditory impairments have only been assessed with auditory brainstem responses; a measure which is unable to distinguish if changes originate from the central or peripheral auditory system. Studies performed in other species, such as mice and guinea-pigs, suggests auditory impairment stems from disrupted OHC amplification. Despite the wide use of the rat in auditory research, these observations have yet to be replicated in the rat animal model. This study used distortion product otoacoustic emissions to assess outer hair cell function in rats that were anesthetized with either isoflurane or a ketamine/xylazine cocktail for approximately 45 min. Results indicate that isoflurane can significantly reduce DPOAE amplitudes compared to ketamine/xylazine, and that responses were more variable with isoflurane than ketamine/xylazine over the 45-min test period. Based on these observations, isoflurane should be used with caution when assessing peripheral auditory function to avoid potentially confounding effects.
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Affiliation(s)
- Adam M Sheppard
- Center for Hearing and Deafness, State University of New York at Buffalo, 137 Cary Hall, 3435 Main Street, Buffalo, NY 14214, USA
| | - Deng-Ling Zhao
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Providence, China
| | - Richard Salvi
- Center for Hearing and Deafness, State University of New York at Buffalo, 137 Cary Hall, 3435 Main Street, Buffalo, NY 14214, USA
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A clinical review of inhalation anesthesia with sevoflurane: from early research to emerging topics. J Anesth 2017; 31:764-778. [PMID: 28585095 PMCID: PMC5640726 DOI: 10.1007/s00540-017-2375-6] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
A large number of studies during the past two decades have demonstrated the efficacy and safety of sevoflurane across patient populations. Clinical researchers have also investigated the effects of sevoflurane, its hemodynamic characteristics, its potential protective effects on several organ systems, and the incidence of delirium and cognitive deficiency. This review examines the clinical profiles of sevoflurane and other anesthetic agents, and focuses upon emerging topics such as organ protection, postoperative cognitive deficiency and delirium, and novel ways to improve postanesthesia outcomes.
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Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon. Neurotoxicol Teratol 2017; 60:102-116. [PMID: 28065636 DOI: 10.1016/j.ntt.2017.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Growing and consistent preclinical evidence, combined with early clinical epidemiological observations, suggest potentially neurotoxic effects of commonly used anesthetic agents in the developing brain. This has prompted the FDA to issue a safety warning for all sedatives and anesthetics approved for use in children under three years of age. Recent studies have identified dexmedetomidine, the potent α2-adrenoceptor agonist, and xenon, the noble gas, as effective anesthetic adjuvants that are both less neurotoxic to the developing brain, and also possess neuroprotective properties in neonatal and other settings of acute ongoing neurologic injury. Dexmedetomidine and xenon are effective anesthetic adjuvants that appear to be less neurotoxic than other existing agents and have the potential to be neuroprotective in the neonatal and pediatric settings. Although results from recent clinical trials and case reports have indicated the neuroprotective potential of xenon and dexmedetomidine, additional randomized clinical trials corroborating these studies are necessary. By reviewing both the existing preclinical and clinical evidence on the neuroprotective effects of dexmedetomidine and xenon, we hope to provide insight into the potential clinical efficacy of these agents in the management of pediatric surgical patients.
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Wang H, Li P, Xu N, Zhu L, Cai M, Yu W, Gao Y. Paradigms and mechanisms of inhalational anesthetics mediated neuroprotection against cerebral ischemic stroke. Med Gas Res 2016; 6:194-205. [PMID: 28217291 PMCID: PMC5223310 DOI: 10.4103/2045-9912.196901] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cerebral ischemic stroke is a leading cause of serious long-term disability and cognitive dysfunction. The high mortality and disability of cerebral ischemic stroke is urging the health providers, including anesthesiologists and other perioperative professioners, to seek effective protective strategies, which are extremely limited, especially for those perioperative patients. Intriguingly, several commonly used inhalational anesthetics are recently suggested to possess neuroprotective effects against cerebral ischemia. This review introduces multiple paradigms of inhalational anesthetic treatments that have been investigated in the setting of cerebral ischemia, such as preconditioning, proconditioning and postconditioning with a variety of inhalational anesthetics. The pleiotropic mechanisms underlying these inhalational anesthetics-afforded neuroprotection against stroke are also discussed in detail, including the common pathways shared by most of the inhalational anesthetic paradigms, such as anti-excitotoxicity, anti-apoptosis and anti-inflammation. There are also distinct mechanisms involved in specific paradigms, such as preserving blood brain barrier integrity, regulating cerebral blood flow and catecholamine release. The ready availability of these inhalational anesthetics bedside and renders them a potentially translatable stroke therapy attracting great efforts for understanding of the underlying mechanisms.
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Affiliation(s)
- Hailian Wang
- Anesthesiology Department of Huashan Hospital, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Peiying Li
- Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Na Xu
- Anesthesiology Department of Huashan Hospital, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Ling Zhu
- Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengfei Cai
- Anesthesiology Department of Huashan Hospital, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Weifeng Yu
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanqin Gao
- Anesthesiology Department of Huashan Hospital, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Pittsburgh Institute of Brain Disorders and Recovery, Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Hoffmann U, Sheng H, Ayata C, Warner DS. Anesthesia in Experimental Stroke Research. Transl Stroke Res 2016; 7:358-67. [PMID: 27534542 PMCID: PMC5016251 DOI: 10.1007/s12975-016-0491-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
Anesthetics have enabled major advances in development of experimental models of human stroke. Yet, their profound pharmacologic effects on neural function can confound the interpretation of experimental stroke research. Anesthetics have species-, drug-, and dose-specific effects on cerebral blood flow and metabolism, neurovascular coupling, autoregulation, ischemic depolarizations, excitotoxicity, inflammation, neural networks, and numerous molecular pathways relevant for stroke outcome. Both preconditioning and postconditioning properties have been described. Anesthetics also modulate systemic arterial blood pressure, lung ventilation, and thermoregulation, all of which may interact with the ischemic insult as well as the therapeutic interventions. These confounds present a dilemma. Here, we provide an overview of the anesthetic mechanisms of action and molecular and physiologic effects on factors relevant to stroke outcomes that can guide the choice and optimization of the anesthetic regimen in experimental stroke.
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Affiliation(s)
- Ulrike Hoffmann
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Huaxin Sheng
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - David S Warner
- Multidisciplinary Neuroprotection Laboratories, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
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8
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Preischemic Administration of Sevoflurane Does not Exert Dose-dependent Effects on the Outcome of Severe Forebrain Ischemia in Rats. J Neurosurg Anesthesiol 2015; 27:216-21. [DOI: 10.1097/ana.0000000000000141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Wang N, Wang J, Zhang R, Wang F, Wang R. The effects of anaesthetics on postoperative physiological reactions: a meta-analysis. Clin Exp Pharmacol Physiol 2015; 42:1127-34. [PMID: 26016612 DOI: 10.1111/1440-1681.12430] [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: 12/29/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to systematically investigate the effects of different anaesthetics on postoperative physiological reactions compared with placebo. The literature search was conducted using three databases: PubMed, EMBASE, and the Cochrane Library. Studies published from January 1990 to January 2015 were screened. The language was restricted to English. Heterogeneity was analyzed by the Q test and I(2) statistic. A fixed-effect model was used for homogenous data and a random-effects model for heterogeneous data. The odds ratio (OR) and 95% confidence interval (CI) were calculated to monitor the incidences of overall adverse events, arterial blood pressure, and cardiac abnormalities. Sensitivity analysis was performed to estimate the strength of the meta-analysis, and publication bias was analyzed using Egger's test. A total of 24 articles were included in this meta-analysis. There were 1,810 and 1,806 cases in the anaesthetic group and the placebo group, respectively. The incidence of overall adverse events was significantly lower in the anaesthetic group compared with the placebo group (OR = 0.57; 95% CI, 0.38-0.84). No publication bias was observed, and no inverse estimates were calculated using sensitivity analysis. There was no significant difference for the incidence of arterial blood pressure (OR = 4.62; 95% CI, 0.90-23.70) and cardiac abnormalities (OR = 1.18; 95% CI, 0.53-2.63) between the two groups. Although the incidence of overall adverse events was decreased in the anaesthetic group, it is impossible to determine whether the use of anaesthetics during surgical operation has a protective effect on postoperative physiological reactions.
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Affiliation(s)
- Na Wang
- Department of Anaesthesiology, First Hospital of Jilin University, Changchun, China
| | - Jinguo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Rui Zhang
- Department of Colorectal Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Fei Wang
- Department of Anaesthesia, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Rui Wang
- Department of Information Engineering, Jilin Business and Technology College, Changchun, China
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Sosunov SA, Ameer X, Niatsetskaya ZV, Utkina-Sosunova I, Ratner VI, Ten VS. Isoflurane anesthesia initiated at the onset of reperfusion attenuates oxidative and hypoxic-ischemic brain injury. PLoS One 2015; 10:e0120456. [PMID: 25799166 PMCID: PMC4370491 DOI: 10.1371/journal.pone.0120456] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/22/2015] [Indexed: 01/16/2023] Open
Abstract
This study demonstrates that in mice subjected to hypoxia-ischemia (HI) brain injury isoflurane anesthesia initiated upon reperfusion limits a release of mitochondrial oxidative radicals by inhibiting a recovery of complex-I dependent mitochondrial respiration. This significantly attenuates an oxidative stress and reduces the extent of HI brain injury. Neonatal mice were subjected to HI, and at the initiation of reperfusion were exposed to isoflurane with or without mechanical ventilation. At the end of HI and isoflurane exposure cerebral mitochondrial respiration, H2O2 emission rates were measured followed by an assessment of cerebral oxidative damage and infarct volumes. At 8 weeks after HI navigational memory and brain atrophy were assessed. In vitro, direct effect of isoflurane on mitochondrial H2O2 emission was compared to that of complex-I inhibitor, rotenone. Compared to controls, 15 minutes of isoflurane anesthesia inhibited recovery of the compex I-dependent mitochondrial respiration and decreased H2O2 production in mitochondria supported with succinate. This was associated with reduced oxidative brain injury, superior navigational memory and decreased cerebral atrophy compared to the vehicle-treated HI-mice. Extended isoflurane anesthesia was associated with sluggish recovery of cerebral blood flow (CBF) and the neuroprotection was lost. However, when isoflurane anesthesia was supported with mechanical ventilation the CBF recovery improved, the event associated with further reduction of infarct volume compared to HI-mice exposed to isoflurane without respiratory support. Thus, in neonatal mice brief isoflurane anesthesia initiated at the onset of reperfusion limits mitochondrial release of oxidative radicals and attenuates an oxidative stress. This novel mechanism contributes to neuroprotective action of isoflurane. The use of mechanical ventilation during isoflurane anesthesia counterbalances negative effect of isoflurane anesthesia on recovery of cerebral circulation which potentiates protection against reperfusion injury.
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Affiliation(s)
- Sergey A. Sosunov
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
| | - Xavier Ameer
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
| | - Zoya V. Niatsetskaya
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
| | - Irina Utkina-Sosunova
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
| | - Veniamin I. Ratner
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
| | - Vadim S. Ten
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York, United States of America
- * E-mail:
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11
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Cellular signaling pathways and molecular mechanisms involving inhalational anesthetics-induced organoprotection. J Anesth 2014; 28:740-58. [PMID: 24610035 DOI: 10.1007/s00540-014-1805-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/04/2014] [Indexed: 01/12/2023]
Abstract
Inhalational anesthetics-induced organoprotection has received much research interest and has been consistently demonstrated in different models of organ damage, in particular, ischemia-reperfusion injury, which features prominently in the perioperative period and in cardiovascular events. The cellular mechanisms accountable for effective organoprotection over heart, brain, kidneys, and other vital organs have been elucidated in turn in the past two decades, including receptor stimulations, second-messenger signal relay and amplification, end-effector activation, and transcriptional modification. This review summarizes the signaling pathways and the molecular participants in inhalational anesthetics-mediated organ protection published in the current literature, comparing and contrasting the 'preconditioning' and 'postconditioning' phenomena, and the similarities and differences in mechanisms between organs. The salubrious effects of inhalational anesthetics on vital organs, if reproducible in human subjects in clinical settings, would be of exceptional clinical importance, but clinical studies with better design and execution are prerequisites for valid conclusions to be made. Xenon as the emerging inhalational anesthetic, and its organoprotective efficacy, mechanism, and relative advantages over other anesthetics, are also discussed.
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12
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Nunes RR, Duval Neto GF, Garcia de Alencar JC, Franco SB, de Andrade NQ, Holanda Dumaresq DM, Cavalcante SL. Anesthetics, cerebral protection and preconditioning. Rev Bras Anestesiol 2014; 63:119-28. [PMID: 23438807 DOI: 10.1016/s0034-7094(13)70204-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 06/16/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents. CONTENT Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use. CONCLUSIONS The brain has the ability to protect itself against ischemia when stimulated. The elucidation of this mechanism enables the application of preconditioning inducing substances (some anesthetics), other drugs, and non-pharmacological measures, such as hypothermia, aimed at inducing tolerance to ischemic lesions.
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13
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Tong L, Cai M, Huang Y, Zhang H, Su B, Li Z, Dong H. Activation of K(2)P channel-TREK1 mediates the neuroprotection induced by sevoflurane preconditioning. Br J Anaesth 2013; 113:157-67. [PMID: 24154701 PMCID: PMC4062297 DOI: 10.1093/bja/aet338] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Preconditioning with volatile anaesthetic agents induces tolerance to focal cerebral ischaemia, although the underlying mechanisms have not been clearly defined. The present study analyses whether TREK-1, a two-pore domain K+ channel and target for volatile anaesthetics, plays a role in mediating neuroprotection by sevoflurane. Methods Differentiated SH-SY5Y cells were preconditioning with sevoflurane and challenged by oxygen–glucose deprivation (OGD). Cell viability and expression of caspase-3 and TREK-1 were evaluated. Rats that were preconditioned with sevoflurane were subjected to middle cerebral artery occlusion (MCAO), and the expression of TREK-1 protein and mRNA was analysed. Neurological scores were evaluated and infarction volume was examined. Results Sevoflurane preconditioning reduced cell death in differentiated SH-SY5Y cells challenged by OGD. Sevoflurane preconditioning reduced infarct volume and improved neurological outcome in rats subjected to MCAO. Sevoflurane preconditioning increased levels of TREK-1 mRNA and protein. Knockdown of TREK-1 significantly attenuated sevoflurane preconditioning-induced neuroprotective effects in vitro and in vivo. Conclusions Sevoflurane preconditioning-induced neuroprotective effects against transient cerebral ischaemic injuries involve TREK-1 channels. These results suggest a novel mechanism for sevoflurane preconditioning-induced tolerance to focal cerebral ischaemia.
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Affiliation(s)
- L Tong
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - M Cai
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - Y Huang
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - H Zhang
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - B Su
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - Z Li
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
| | - H Dong
- Department of Anesthesiology, Xijing Hospital, Xi'an, Shanxi 710032, China
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14
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Nunes RR, Duval Neto GF, de Alencar JCG, Franco SB, de Andrade NQ, Dumaresq DMH, Cavalcante SL. Anesthetics, cerebral protection and preconditioning. Braz J Anesthesiol 2013; 63:119-28. [PMID: 24565096 DOI: 10.1016/j.bjane.2012.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 06/16/2012] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents. CONTENT Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use. CONCLUSIONS The brain has the ability to protect itself against ischemia when stimulated. The elucidation of this mechanism enables the application of preconditioning inducing substances (some anesthetics), other drugs, and non-pharmacological measures, such as hypothermia, aimed at inducing tolerance to ischemic lesions.
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Affiliation(s)
- Rogean Rodrigues Nunes
- TSA; MSc and PhD in Anesthetics; Postgraduate in Cardiology, Universidade Federal do Ceará (UFC); Jointly Responsible for the Center for Teaching and Training (CET) of Hospital Geral de Fortaleza (HGF); Medicine Professor of Fachristus; Postgraduate in Clinical Engineering, Universidade de Fortaleza (Unifor); Vice-Chair of the Research Ethics Committee, Hospital São Carlos, Fortaleza, Ceará.
| | | | | | | | | | - Danielle Maia Holanda Dumaresq
- TSA; MSc, UFC; Responsible for CET-IJF; Chairman of the Pediatric Anesthesia Committee, Sociedade Brasileira de Anestesiologia (SBA) - 2011; Medicine Professor of Fachristus, Fortaleza, Ceará
| | - Sara Lúcia Cavalcante
- PhD; Professor, Faculdade de Medicina, UFC; Corresponsible for the CET of the HGF from Hospital São Carlos, Fortaleza Ceara, Brazil
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Wise-Faberowski L, Osorio-Lujan S. Acute and sustained isoflurane neuroprotection: The effect of culture age and duration of oxygen and glucose deprivation. Brain Inj 2013; 27:444-53. [DOI: 10.3109/02699052.2012.750755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Chaparro E, Erasso D, Quiroga C, Bosco G, Parmagnani A, Rubini A, Mangar D, Camporesi E. Repetitive intraperitoneal caspase-3 inhibitor and anesthesia reduces neuronal damage. J Enzyme Inhib Med Chem 2012. [DOI: 10.3109/14756366.2012.740478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eduardo Chaparro
- University of South Florida, Molecular Pharmacology and Physiology,
Tampa, FL, USA,
| | - Diana Erasso
- University of South Florida, Molecular Pharmacology and Physiology,
Tampa, FL, USA,
| | - Carolina Quiroga
- University of South Florida, Molecular Pharmacology and Physiology,
Tampa, FL, USA,
| | - Gerardo Bosco
- University of Padova, Biomedical sciences,
Via Marzolo, 3, Padova, 35131 Italy
| | - Andrea Parmagnani
- University of Padova, Biomedical sciences,
Via Marzolo, 3, Padova, 35131 Italy
| | - Alessandro Rubini
- University of Padova, Biomedical sciences,
Via Marzolo, 3, Padova, 35131 Italy
| | - Devanand Mangar
- University of South Florida, Molecular Pharmacology and Physiology,
Tampa, FL, USA,
| | - Enrico Camporesi
- Florida Gulf-to-Bay Anesthesiology Associates Tampa General Hospital,
Tampa, FL, USA
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Lasarzik I, Noppens RR, Wolf T, Bauer H, Luh C, Werner C, Engelhard K, Thal SC. Dose-dependent influence of sevoflurane anesthesia on neuronal survival and cognitive outcome after transient forebrain ischemia in Sprague-Dawley rats. Neurocrit Care 2012; 15:577-84. [PMID: 21618067 DOI: 10.1007/s12028-011-9562-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Volatile anesthetics reduce postischemic neurohistopathological injury and improve neurological outcome in various animal models. However, the isoflurane concentrations above 1 minimum alveolar concentration (MAC) have been associated with reduced neuronal survival and impaired functional outcome. The aim of this study was to evaluate if 1.8 MAC sevoflurane alters postischemic neuronal survival and neurologic outcome compared with 0.45 MAC sevoflurane. METHODS In this study, 20 fasted male Sprague-Dawley rats were randomly assigned to treatment groups with 1 or 4 vol.% sevoflurane end-tidal concentration. Cerebral ischemia was induced by bilateral carotid artery occlusion and hemorrhagic hypotension (BCAO). The cognitive outcome was assessed after 7 days using the object recognition test. Animals were then re-anesthetized and brains were removed for neurohistopathological analysis of the hippocampus (CA1) and cortex using hematoxylin-eosin staining. RESULTS Physiologic parameters were not different between both the treatment groups. The number of viable neurons (median [Q1, Q3]) in the CA1 region on postischemic day 7 was increased after high-dose sevoflurane compared with low-dose sevoflurane (1645 [453, 1825] vs. 3222 [2920, 3993] neurons/ROI, P < 0.05). Results of the object recognition test were not different between both the treatment groups. CONCLUSIONS Postischemic neuronal survival was increased with 1.8 MAC compared with 0.45 MAC sevoflurane. Therefore, experimental models of cerebral ischemia should account for neuroprotective effects of sevoflurane with increasing concentrations. To ensure minimal interference of sevoflurane on neuronal survival, a low inspired concentration should be used and fluctuations in the depth of anesthesia should be limited.
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Affiliation(s)
- Irina Lasarzik
- Department of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Langenbeckstrasse 1, 55131 Mainz, Germany
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18
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Different strokes for different folks: the rich diversity of animal models of focal cerebral ischemia. J Cereb Blood Flow Metab 2010; 30:1412-31. [PMID: 20485296 PMCID: PMC2949237 DOI: 10.1038/jcbfm.2010.66] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
No single animal model is able to encompass all of the variables known to affect human ischemic stroke. This review highlights the major strengths and weaknesses of the most commonly used animal models of acute ischemic stroke in the context of matching model and experimental aim. Particular emphasis is placed on the relationships between outcome and underlying vascular variability, physiologic control, and use of models of comorbidity. The aim is to provide, for novice and expert alike, an overview of the key controllable determinants of experimental stroke outcome to help ensure the most effective application of animal models to translational research.
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van den Bergh WM. Is There a Future for Neuroprotective Agents in Cardiac Surgery? Semin Cardiothorac Vasc Anesth 2010; 14:123-35. [DOI: 10.1177/1089253210370624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article gives an overview of neuroprotective drugs that were recently tested in clinical trials in cardiac surgery. Also, recommendations are given for successful translational research and considerations for management during cardiac surgery.
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Isoflurane anesthesia induced persistent, progressive memory impairment, caused a loss of neural stem cells, and reduced neurogenesis in young, but not adult, rodents. J Cereb Blood Flow Metab 2010; 30:1017-30. [PMID: 20068576 PMCID: PMC2949194 DOI: 10.1038/jcbfm.2009.274] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Isoflurane and related anesthetics are widely used to anesthetize children, ranging from premature babies to adolescents. Concerns have been raised about the safety of these anesthetics in pediatric patients, particularly regarding possible negative effects on cognition. The purpose of this study was to investigate the effects of repeated isoflurane exposure of juvenile and mature animals on cognition and neurogenesis. Postnatal day 14 (P14) rats and mice, as well as adult (P60) rats, were anesthetized with isoflurane for 35 mins daily for four successive days. Object recognition, place learning and reversal learning as well as cell death and cytogenesis were evaluated. Object recognition and reversal learning were significantly impaired in isoflurane-treated young rats and mice, whereas adult animals were unaffected, and these deficits became more pronounced as the animals grew older. The memory deficit was paralleled by a decrease in the hippocampal stem cell pool and persistently reduced neurogenesis, subsequently causing a reduction in the number of dentate gyrus granule cell neurons in isoflurane-treated rats. There were no signs of increased cell death of progenitors or neurons in the hippocampus. These findings show a previously unknown mechanism of neurotoxicity, causing cognitive deficits in a clearly age-dependent manner.
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21
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Lee JH, Kwon O, Kwon JY. The effects of desflurane on delayed neuronal injury after transient forebrain ischemia in the rat. Korean J Anesthesiol 2009; 57:195-202. [PMID: 30625857 DOI: 10.4097/kjae.2009.57.2.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Volatile anesthetics have been shown protective against focal or global cerebral ischemia in animal models. However isoflurane failed to provide persistent protection because of late onset of apoptosis after ischemia. The aim of this study was to elucidate the effects of desflurane on delayed neuronal damage after forebrain ischemia. METHODS Rats were divided into 2 groups and anesthetized with desflurane or isoflurane. Forebrain ischemia was produced by both induced hypotension and 10 minutes of common carotid artery clamping. After 2 days and 2 weeks, rats were killed under anesthesia and brains were removed for Western blot analysis of Bcl-2, Bax, and caspase 3 expression and histopathologic study. RESULTS The apoptotic cell numbers in hippocampal CA1 area were increased after 2 weeks, and there was no significant difference between groups. There was no significant difference in caspase 3 expression between groups. The Bax/Bcl-2 ratio was increased at 2 weeks after ischemia, and there was no significant difference between group. CONCLUSIONS The data indicate that desflurane also delays but does not prevent the neuronal injury caused by ischemia. Desflurane reduced the development of apoptosis early after ischemia but did not prevent it at later stages of post-ischemic recovery.
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Affiliation(s)
- Jeong Han Lee
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Osun Kwon
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jae Young Kwon
- Department of Anesthesiology and Pain Medicine, Pusan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Matchett GA, Allard MW, Martin RD, Zhang JH. Neuroprotective effect of volatile anesthetic agents: molecular mechanisms. Neurol Res 2009; 31:128-34. [PMID: 19298752 DOI: 10.1179/174313209x393546] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Intra-operative cerebral ischemia can be catastrophic, and volatile anesthetic agents have been recognized for their potential neuroprotective properties since the 1960s. In this review, we examine the neuroprotective effects of five volatile anesthetic agents in current or recent clinical use: isoflurane, sevoflurane, desflurane, halothane and enflurane. METHODS A review of publications in the National Library of Medicine and National Institutes of Health database from 1970 to 2007 was conducted. RESULTS Volatile anesthetic agents have been shown to be neuroprotective in multiple animal works of ischemic brain injury. Short-term neuroprotection (<1 week post-ischemia) in experimental cerebral ischemia has been reported in multiple works, although long-term neuroprotection (> or = 1 week post-ischemia) remains controversial. Comparison works have not demonstrated superiority of one specific volatile agent over another in experimental models of brain injury. Relatively few human works have examined the protective effects of volatile anesthetic agents and conclusive evidence of a neuroprotective effect has yet to emerge from human works. CONCLUSION Proposed mechanisms related to the neuroprotective effect of volatile anesthetic agents include activation of ATP-dependent potassium channels, up-regulation of nitric oxide synthase, reduction of excitotoxic stressors and cerebral metabolic rate, augmentation of peri-ischemic cerebral blood flow and up-regulation of antiapoptotic factors including MAP kinases.
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Affiliation(s)
- Gerald A Matchett
- Department of Anesthesiology, School of Medicine, Loma Linda University, Loma Linda, CA 92350, USA
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23
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Jiang W, Büchele F, Papazoglou A, Döbrössy M, Nikkhah G. Ketamine anaesthesia interferes with the quinolinic acid-induced lesion in a rat model of Huntington's disease. J Neurosci Methods 2009; 179:219-23. [PMID: 19428530 DOI: 10.1016/j.jneumeth.2009.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 10/21/2022]
Abstract
Ketamine, a non-competitive N-methyl-D-aspartate (NMDA) antagonist, is a commonly used injectable anaesthetic agent. In the present study, ketamine- and isoflurane-induced anaesthesias were tested to identify the influence of different anaesthesia methods in conjunction with the unilateral quinolinic acid-induced excitotoxic lesion rat model of Huntington's disease (HD). Quinolinic acid, a glutamate analogue, exerts its excitotoxic effect via the NMDA receptor, the principle target of ketamine as well, rendering the choice of anaesthesia an important pharmacokinetic issue. Twenty Sprague-Dawley females were lesioned using quinolinic acid: one group was anaesthetised with ketamine and the other with isoflurane. The injection coordinates and the dosage of quinolinic acid were identical. Two weeks post-lesion, the animals were tested on apomorphine-induced rotation test, followed by perfusion, immunohistochemical and volumetric analysis. The isoflurane, compared with the ketamine, anaesthetised animals showed greater ipsilateral rotation behaviour, larger striatal lesions and significant differences in other measurements reflecting the extent of the lesion. The data demonstrates that the use of ketamine anaesthesia in the excitotoxic model of HD can severely compromise the development of the lesion.
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Affiliation(s)
- Wei Jiang
- Laboratory of Molecular Neurosurgery, Dept. of Stereotactic and Functional Neurosurgery, Neurocenter, Albert-Ludwigs-University, Breisacher Str. 64, D-79106 Freiburg, Germany
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Wu GJ, Chen WF, Sung CS, Jean YH, Hung CH, Chen FA, Hsieh MH, Wen ZH. Isoflurane attenuates dynorphin-induced cytotoxicity and downregulation of Bcl-2 expression in differentiated neuroblastoma SH-SY5Y cells. Acta Anaesthesiol Scand 2009; 53:55-60. [PMID: 19032555 DOI: 10.1111/j.1399-6576.2008.01828.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND It has been proposed that the volatile anesthetic isoflurane induces neuroprotection and that the endogenous opioid peptide dynorphin induces neurocytotoxicity in cells. The levels of dynorphin are often significantly elevated in neuropathophysiological conditions, and dynorphin can directly induce toxicity. However, the neuroprotective effects of isoflurane on dynorphin-induced cytotoxicity are still unclear. METHODS In order to determine the effect of isoflurane on dynorphin-induced cytotoxicity in neuronal cells, we have designed a device wherein cultured human neuroblastoma SH-SY5Y cells can be exposed to isoflurane. Fully differentiated SH-SY5Y cells were obtained by treating the cells with retinoic acid for 6 days. We examined SH-SY5Y cell survival, apoptosis, and antiapoptotic protein expression by cell viability, terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling stain, and Western blot analysis, respectively. RESULTS After 16 h of dynorphin (10 microM) treatment, the SH-SY5Y cells showed significant cytotoxicity, apoptosis, and downregulation of the antiapoptotic Bcl-2 protein expression. These effects of dynorphin were significantly inhibited by isoflurane exposure for 32 h [pretreatment for 16 h and posttreatment (after dynorphin treatment) for 16 h]. CONCLUSION Thus, our results suggest that isoflurane exerts neuroprotective effects in the case of dynorphin-induced pathophysiological disruption.
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Affiliation(s)
- G-J Wu
- Department of Anesthesiology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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25
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Porcine global flash multifocal electroretinogram: Possible mechanisms for the glaucomatous changes in contrast response function. Vision Res 2008; 48:1726-1734. [DOI: 10.1016/j.visres.2008.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 04/09/2008] [Accepted: 05/07/2008] [Indexed: 01/08/2023]
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Isoflurane inhibits protein kinase Cgamma and calcium/calmodulin dependent protein kinase ii-alpha translocation to synaptic membranes in ischemic mice brains. Neurochem Res 2008; 33:2302-9. [PMID: 18473171 DOI: 10.1007/s11064-008-9727-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
Abstract
Volatile anesthetics isoflurane possibly improves the ischemic brain injury. However, its molecular actions are still unclear. In ischemia, protein kinase C (PKC)gamma and calcium/calmodulin dependent protein kinase II (CaMKII)-alpha are persistently translocated from cytosol to cell membranes, and diminish these translocation suggested to be neuroprotective. We thus tested a hypothesis that isoflurane inhibits PKCgamma and CaMKII-alpha translocation after ischemic brain insults. C57Bl/6J male mice were made to inhale 1 or 2 MAC isoflurane, after which 3 or 5 min cerebral ischemia was induced by decapitation. The sampled cerebrum cortex was then homogenized and centrifuged into crude synaptosomal fractions (P2), cytosolic fractions (S3), and particulate fractions (P3). CaMKII-alpha and PKCgamma levels of these fractions were analyzed by immunoblotting. PKCgamma and CaMKII-alpha are translocated to synaptic membrane from cytosol by cerebral ischemia, although isoflurane significantly inhibited such translocation. These results may explain in part the cellular and molecular mechanisms of neuroprotective effects of isoflurane.
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Abstract
PURPOSE OF REVIEW There is a considerable risk of cerebral ischemia during anesthesia and surgery. Anesthetic agents have been shown to have a profound effect on the pathophysiology of cerebral ischemia. The present review provides a brief historical review and details new information about the anesthetic effects on the ischemic brain. RECENT FINDINGS Although anesthetics have been shown to reduce ischemic cerebral injury, the durability of this neuroprotection has been questioned. Recent data indicate that, under the right circumstances, anesthetic neuroprotection can be sustained for at least 2-4 weeks; the durability of this protection is dependent upon the experimental model, control of physiologic parameters and the assurance of the adequacy of reperfusion. In addition, volatile anesthetics have been shown to accelerate postischemic neurogenesis; this suggests that anesthetics may enhance the endogenous reparative processes in the injured brain. SUMMARY The available data indicate that anesthetics can provide long-term durable protection against ischemic injury that is mild to moderate in severity. Experimental data do not provide support for the premise that anesthetics reduce injury when the ischemic injury is severe.
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Affiliation(s)
- Brian P Head
- Department of Anesthesiology, University of California-San Diego, CA, USA.
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Baldauf K, Henrich-Noack P, Reymann KG. Detrimental effects of halothane narcosis on damage after endothelin-1-induced MCAO. J Neurosci Methods 2007; 162:14-8. [PMID: 17197033 DOI: 10.1016/j.jneumeth.2006.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 11/29/2006] [Accepted: 11/30/2006] [Indexed: 12/01/2022]
Abstract
The influence of anaesthesia in experimental stroke research is controversial. We addressed this problem using the model of endothelin-1-induced occlusion of the middle cerebral artery (eMCAO). This model provided the opportunity to compare the infarct volumes of rats which were under halothane anaesthesia during eMCAO induction with the lesions of rats which were without anaesthesia during eMCAO. All animals were implanted with guide cannulae which allowed the induction of ischaemia in freely moving animals. For comparison, one group of animals was exposed to halothane during the induction of ischaemia. Seven days after eMCAO, the average infarct volume of halothane-anaesthetised rats was significantly larger than the lesion in freely moving animals. This difference was mainly due to increased cortical damage, whereas the striatum was much less influenced. The cortical infarct volume 21 days after induction of eMCAO under anaesthesia was significantly reduced compared to the infarct volume 7 days after eMCAO under anaesthesia. Our results indicate that halothane anaesthesia during eMCAO can cause a transient cortical increase in ischaemic infarct volume. The influence of volatile anaesthetics on ischaemic pathophysiology should be taken into consideration when preclinically testing potential neuroprotective drugs for clinical applications.
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Affiliation(s)
- Kathrin Baldauf
- Leibniz Institute for Neurobiology, Brenneckestrasse 6, D-39118 Magdeburg, Germany.
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29
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Anesthetics and the Injured Brain. Brain Inj 2001. [DOI: 10.1007/978-1-4615-1721-4_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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