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Carvalho LIMD, Azi LMTDA, Leal PDC, Lorentz MN, Diego LADS, Schmidt AP. Anesthesia and perioperative care management in patients with Dengue Fever: considerations and challenges. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:844511. [PMID: 38723714 DOI: 10.1016/j.bjane.2024.844511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Affiliation(s)
| | - Liana Maria Tôrres de Araújo Azi
- Hospital Universitário Professor Edgard Santos, Departamento de Anestesiologia, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Plinio da Cunha Leal
- Hospital São Domingos, Departamento de Anestesiologia, São Luís, MA, Brazil; Universidade Federal do Maranhão (UFMA), São Luís, MA, Brazil
| | | | | | - André P Schmidt
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Anestesia e Medicina Perioperatória, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Santa Casa de Porto Alegre, Serviço de Anestesia, Porto Alegre, RS, Brazil; Hospital Nossa Senhora da Conceição, Serviço de Anestesia, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-graduação em Ciências Cirúrgicas, Porto Alegre, RS, Brazil; Faculdade de Medicina da Universidade de São Paulo (FMUSP), Programa de Pós-Graduação em Anestesiologia, Ciências Cirúrgicas e Medicina Perioperatória, São Paulo, SP, Brazil
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Stomach, liver, kidney and skeletal muscle autoregulation evaluated by near-infrared spectroscopy in a swine model. J Clin Monit Comput 2023; 37:899-909. [PMID: 36596969 DOI: 10.1007/s10877-022-00956-5] [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: 05/25/2022] [Revised: 11/16/2022] [Accepted: 11/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Different organs have different autoregulatory capacities for blood pressure changes and/or circulatory volume changes. This study assessed the autoregulation of the stomach, liver, kidney and skeletal muscle, under baseline, hypovolemic, and post-fluid-resuscitation conditions using near-infrared spectroscopy (NIRS). METHODS Ten pigs (bodyweight 24.5 ± 0.5 kg) were anesthetized with 2.5% isoflurane and administered 0.5, 1, 2 and 5 µg kg- 1 min- 1 of phenylephrine at 10-min intervals, followed by similar stepwise infusion of sodium nitroprusside (SNP) to induce a wide range of mean arterial pressures (MAPs). A 600-ml bleed was induced to create the hypovolemic condition, and only phenylephrine was re-administered. Hydroxyethyl starch (600 ml) was infused to create the post-fluid-resuscitation condition, and phenylephrine and SNP were re-administered. Average relationships between mean arterial pressure (MAP) and each tissue oxygenation index (TOI) were assessed, and the individual relationships were evaluated based on the correlation coefficients between MAP and TOI during each vasoactive drug infusion. RESULTS Based on the evaluation using each TOI as a substitute of blood flow, the kidney autoregulation was robust, similar to muscle, but had a prominent lower limit. The stomach had weaker autoregulation than the kidney and muscle. The liver had no autoregulation. The kidney TOI showed 2-fold greater changes in response to volume condition changes than the stomach and liver TOIs. CONCLUSION In our NIRS-based assessment of autoregulatory capacity, the liver oxygenation is highly blood pressure dependent, and the kidney is highly susceptible and the skeletal muscle is highly tolerable to low blood pressure and volume loss.
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Mirra A, Gamez Maidanskaia E, Carmo LP, Levionnois O, Spadavecchia C. How is depth of anaesthesia assessed in experimental pigs? A scoping review. PLoS One 2023; 18:e0283511. [PMID: 36952576 PMCID: PMC10035875 DOI: 10.1371/journal.pone.0283511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/09/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Despite the large number of pigs involved in translational studies, no gold standard depth of anaesthesia indicators are available. We undertook a scoping review to investigate and summarize the evidence that sustains or contradicts the use of depth of anaesthesia indicators in this species. METHODS Medline, Embase and CAB abstract were searched up to September 22nd 2022. No limits were set for time, language and study type. Only original articles of in vivo studies using pigs or minipigs undergoing general anaesthesia were included. The depth of anaesthesia indicators reported in the selected papers were divided in two categories: A, indicators purposely investigated as method to assess depth of anaesthesia; B, indicators reported but not investigated as method to assess depth of anaesthesia. RESULTS Out of 13792 papers found, 105 were included after the screening process. Category A: 17 depth of anaesthesia indicators were found in 19 papers. Studies were conducted using inhalant anaesthetics as the main anaesthetic agent in the majority of the cases (13/19 = 68.4%), while 3/19 (15.8%) used propofol. The most investigated depth of anaesthesia indicators were bispectral index (8/19 = 42.1%) and spectral edge frequency 95% (5/19 = 26.3%). Contrasting results about the specific usefulness of each depth of anaesthesia indicators were reported. Category B: 23 depth of anaesthesia indicators were found in 92 papers. The most reported depth of anaesthesia indicators were: motor response following a stimulus (37/92 = 40.2%), depth of anaesthesia scores (21/92 = 23.3%), bispectral index (16/92 = 17.8%) and spectral edge frequency 95% (9/92 = 9.8%). CONCLUSION Results highlight the lack of scientifically valid and reliable indicators to ensure adequate depth of anaesthesia in pigs.
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Affiliation(s)
- Alessandro Mirra
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ekaterina Gamez Maidanskaia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Luís Pedro Carmo
- Department of Clinical Research und Public Health (DCR-VPH), Vetsuisse Faculty, Veterinary Public Health Institute, University of Bern, Bern, Switzerland
- Norwegian Veterinary Institute, Ås, Norway
| | - Olivier Levionnois
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Claudia Spadavecchia
- Anaesthesiology and Pain Therapy Section, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Silva RCCD, Bezerra JJL, Medeiros MFT. Analysis of historical botanical reports of species of Fabaceae in Historia Naturalis Brasiliae (1648). RODRIGUÉSIA 2022. [DOI: 10.1590/2175-7860202273061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Historia Naturalis Brasiliae, a reference work for Brazilian natural sciences, contains information on species observed by 17th century naturalists. Among the reports, the botanical family Fabaceae deserves to be highlighted among the taxa that make up the Brazilian flora due to its richness of species and economic interest. In this sense, the objective of the present study was to retrieve information regarding Fabaceae cited in Historia Naturalis Brasiliae by naturalists Piso & Marggraf (1648), with the aim of identifying potential resources of Brazilian flora in conjunction with local knowledge about potential species today and how historical changes have influenced the use of these plant resources. Documentary data were analyzed in the original source and in Pickel’s 2008 review work (Flora do Nordeste do Brasil). The information was organized in a database and analyzed qualitatively and quantitatively. The analysis recovered 49 species belonging to the botanical family Fabaceae in the work. Of this total, 33 species and two genera had their use mentioned in the work, the reports of which were subdivided into four categories, with the highest percentage being for the category of medicinal use (69.23%). Of the plants reported for medicinal use, 18 species and one genus had no records in contemporary works. The analyses presented here contribute to expanding the knowledge of Fabaceae, the recovery of knowledge of plants from past centuries, and the discussion of the influence of factors that cause historical changes in use patterns, thus enriching studies in the field of botany, particularly historical ethnobotany.
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Moody AE, Beutler BD, Moody CE. Predicting cost of inhalational anesthesia at low fresh gas flows: impact of a new generation carbon dioxide absorbent. Med Gas Res 2021; 10:64-66. [PMID: 32541130 PMCID: PMC7885709 DOI: 10.4103/2045-9912.285558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
It is well known that low fresh gas flows result in lower cost of inhalational agents. A new generation of carbon dioxide absorbents allows low flow anesthesia with all anesthetics but these new compounds are more expensive. This study examines the cost of inhalational anesthesia at different fresh gas flows combined with the cost of absorbent. The cost of sevoflurane and desflurane is lower at low fresh gas flows. Paradoxically the cost of isoflurane is cheaper at 2 L/min than at lower fresh gas flows due to increased cost of carbon dioxide absorbent. Therefore low fresh gas flows should be used when feasible with sevoflurane and desflurane, but higher fresh gas flows up to 2 L/min may be more economical with isoflurane during maintenance phase of anesthesia.
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Affiliation(s)
- Alastair E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Bryce D Beutler
- Department of Internal Medicine, University of Nevada Reno, Reno, NV, USA
| | - Catriona E Moody
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
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Kurita T, Kawashima S, Ibrahim Khaleelullah MMS, Nakajima Y. Influence of hemorrhage and subsequent fluid resuscitation on transcranial motor-evoked potentials under desflurane anesthesia in a swine model. J Clin Monit Comput 2021; 36:239-246. [PMID: 33523354 DOI: 10.1007/s10877-020-00644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Hemorrhage increases the effect of propofol and could contribute to false-positive transcranial motor-evoked potential (TcMEP) responses under total intravenous anesthesia (TIVA). We investigated the influence of hemorrhage and subsequent fluid resuscitation on TcMEPs under desflurane anesthesia. METHODS Sixteen swine (25.4 ± 0.4 kg) were anesthetized with a 4% end-tidal desflurane concentration (EtDes), which was incrementally increased to 6%, 8%, and 10% and then returned to 4% every 15 min. This procedure was repeated twice (baseline). After baseline measurements, animals were allocated to either the hemorrhage (n = 12) or control (n = 4) group. In the hemorrhage group, 600 ml of blood was removed and the EtDes protocol described above was applied. Hypovolemia was resuscitated using 600 ml of hydroxyethyl starch and the EtDes protocol was applied again. TcMEPs were measured at each EtDes. In the control group, measurements were performed without hemorrhage or fluid infusion. RESULTS TcMEP responses were observed in all conditions in all limbs with 4% EtDes (0.4 MAC). TcMEP amplitudes decreased according to the EtDes to a greater degree in the lower limbs compared with the upper limbs. Hemorrhage enhanced the effect of desflurane on TcMEP amplitudes, and decreased TcMEP by 41 ± 12% in upper limbs and 63 ± 17% in lower limbs compared with baseline. Subsequent fluid resuscitation did not reverse TcMEP amplitudes. CONCLUSIONS TcMEP amplitudes decrease during hemorrhage under desflurane anesthesia. This phenomenon might result from an enhanced effect of desflurane on the spinal motor pathway without increasing the desflurane concentration.
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Affiliation(s)
- Tadayoshi Kurita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
| | | | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan
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Egan ED, Johnson KB. The Influence of Hemorrhagic Shock on the Disposition and Effects of Intravenous Anesthetics: A Narrative Review. Anesth Analg 2020; 130:1320-1330. [PMID: 32149755 DOI: 10.1213/ane.0000000000004654] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The need to reduce the dose of intravenous anesthetic in the setting of hemorrhagic shock is a well-established clinical dogma. Considered collectively,; the body of information concerning the behavior of intravenous anesthetics during hemorrhagic shock, drawn from animal and human data, confirms that clinical dogma and informs the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The physiologic changes during hemorrhagic shock can alter pharmacokinetics and pharmacodynamics of intravenous anesthetics. Decreased size of the central compartment and central clearance caused by shock physiology lead to an altered dose-concentration relationship. For most agents and adjuncts, shock leads to substantially higher concentrations and increased effect. The notable exception is etomidate, which has relatively unchanged pharmacokinetics during shock. Increased concentrations lead to increased primary effect as well as increased side effects, notably cardiovascular effects. Pharmacokinetic changes are essentially reversed for all agents by fluid resuscitation. Propofol is unique among agents in that, in addition to the pharmacokinetic changes, it exhibits increased potency during shock. The pharmacodynamic changes of propofol persist despite fluid resuscitation. The persistence of these pharmacodynamic changes during shock is unlikely to be due to increased endogenous opiates, but is most likely due to increased fraction of unbound propofol. The stage of shock also appears to influence the pharmacologic changes. The changes are more rapid and pronounced as shock physiology progresses to the uncompensated stage. Although scant, human data corroborate the findings of animal studies. Both the animal and human data inform the rational selection and administration of intravenous anesthetics in the setting of hemorrhagic shock. The well-entrenched clinical dogma that etomidate is a preferred induction agent in patients experiencing hemorrhagic shock is firmly supported by the evidence. Propofol is a poor choice for induction or maintenance of anesthesia in severely bleeding patients, even with resuscitation; this can include emergent trauma cases or scheduled cases that routinely have mild or moderate blood loss.
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Affiliation(s)
- Ezekiel D Egan
- From the Department of Anesthesiology, University of Utah, Salt Lake City, Utah
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Kurita T, Kawashima S, Morita K, Nakajima Y. Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation. J Intensive Care 2020; 8:27. [PMID: 32318269 PMCID: PMC7158138 DOI: 10.1186/s40560-020-00443-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022] Open
Abstract
Background Few studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation. Methods Ten pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg−1 min−1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estimated total blood volume). Only phenylephrine was readministered (same protocol). Hypovolemia was reversed by infusing 600 ml hydroxyethyl starch, before readministering phenylephrine and SNP. The relationships between mean arterial pressure (MAP) and cerebral, thoracic, and lumbar spinal cord tissue oxygenation indices (TOIs) were evaluated. Results Thoracic and lumbar spinal cord TOIs were approximately 15% and 10% lower, respectively, than the cerebral TOI at similar MAPs. The average relationship between MAP and each TOI showed an autoregulatory pattern, but negative correlations were observed in the cerebral TOI during phenylephrine infusion. A 600-ml bleed lowered each relationship < 5% and subsequent fluid resuscitation did not change the relationship. Individual oxygenation responses to blood pressure indicated that the spinal cord is more pressure-passive than the cerebrum. Paradoxical responses (an inverse relationship of tissue oxygenation to MAP) were observed particularly in cerebrum during phenylephrine infusion and were rare in the spinal cord. Conclusions Spinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension.
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Affiliation(s)
- Tadayoshi Kurita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Shingo Kawashima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Koji Morita
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
| | - Yoshiki Nakajima
- Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192 Japan
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Engdahl AJ, Parrino CR, Wasicek PJ, Galvagno SM, Brenner ML, Anders MG, Conti B, Rock P, McCunn M. Anesthetic Management of Patients After Traumatic Injury With Resuscitative Endovascular Balloon Occlusion of the Aorta. Anesth Analg 2020; 129:e146-e149. [PMID: 31634204 DOI: 10.1213/ane.0000000000004130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing maneuver for noncompressible torso hemorrhage. To our knowledge, this single-center brief report provides the most extensive anesthetic data published to date on patients who received REBOA. As anticipated, patients were critically ill, exhibiting lactic acidosis, hypotension, hyperglycemia, hypothermia, and coagulopathy. All patients received blood products during their index operations and received less inhaled anesthetic gas than normally required for healthy patients of the same age. This study serves as an important starting point for clinician education and research into anesthetic management of patients undergoing REBOA.
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Affiliation(s)
- Ashton J Engdahl
- From the University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Philip J Wasicek
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel M Galvagno
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.,Division of Critical Care Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Megan L Brenner
- Department of Surgery, University of California Riverside School of Medicine, Riverside, California
| | - Megan G Anders
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Critical Care Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bianca Conti
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, Maryland
| | - Peter Rock
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Critical Care Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Maureen McCunn
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland.,Division of Trauma Anesthesiology, R Adams Cowley Shock Trauma Center, Baltimore, Maryland.,Division of Critical Care Anesthesiology, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland
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Assessment of cerebral and renal autoregulation using near-infrared spectroscopy under normal, hypovolaemic and postfluid resuscitation conditions in a swine model. Eur J Anaesthesiol 2019; 36:531-540. [DOI: 10.1097/eja.0000000000001021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kido K, Shindo Y, Toda S, Masaki E. Expression of β-endorphin in peripheral tissues after systemic administration of lipopolysaccharide as a model of endotoxic shock in mice. ANNALES D'ENDOCRINOLOGIE 2019; 80:117-121. [DOI: 10.1016/j.ando.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 02/08/2023]
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Kurita T, Morita K, Sato S. The Influence of Hypovolemia and Fluid Resuscitation During Hemorrhagic Shock on Apneic Oxygen Desaturation After Preoxygenation in a Swine Model. Anesth Analg 2016; 121:1555-61. [PMID: 26414602 DOI: 10.1213/ane.0000000000000979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients experiencing major bleeding often require both aggressive fluid resuscitation and rapid sequence tracheal intubation. The influence of hemorrhage-induced hypovolemia, and/or subsequent fluid resuscitation, on the time until critical oxygen desaturation is not well described. We studied the time to oxygen desaturation in a pig model of hemorrhage shock and colloid resuscitation. METHODS After anesthetic induction with isoflurane, 9 swine (mean ± SD = 25.3 ± 0.6 kg) were studied with the use of a stepwise hemorrhage and fluid resuscitation model with 4 sequential stages: 600 mL hemorrhage, 600 mL hydroxyethyl starch infusion, a further 600 mL hemorrhage, and a second 600 mL hydroxyethyl starch infusion. At each stage, after 5 minutes of mechanical ventilation with 100% oxygen, we induced apnea and measured the time to oxygen desaturation (oxygen saturation [SpO2] <70%). Hemodynamic and blood gas variables were recorded, and the cerebral and peripheral tissue oxygenation indices were recorded by near-infrared spectroscopy. RESULTS The times ± SD to SpO2 <70% at each stage were 136 ± 41 (baseline), 147 ± 41 (hemorrhage), 131 ± 38 (resuscitation), 147 ± 38 (repeat hemorrhage), and 134 ± 36 seconds (repeat resuscitation). The mean differences in times before and after hemorrhage were 11.2 (6.5 to 16.0, P = 0.0052) and 16.0 (11.0 to 21.0, P < 0.0001), respectively. PaO2 before and after apneic desaturation (at SpO2 < 70%) was not different between stages. On the basis of tissue oxygenation index findings, hypovolemia decreased oxygen consumption, and fluid resuscitation recovered this parameter. CONCLUSIONS In patients with acute hemorrhagic shock, a hypovolemic state increases the duration of apnea until critical oxygen desaturation. Clinicians should thus consider the relationship between fluid resuscitation and time to desaturation when performing tracheal intubation in such patients.
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Affiliation(s)
- Tadayoshi Kurita
- From the Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Kleine SA, Quandt JE, Hofmeister EH, Peroni J. The effect of midazolam on the recovery quality, recovery time and the minimum alveolar concentration for extubation in the isoflurane-anesthetized pig. Lab Anim 2014; 49:111-6. [PMID: 25378139 DOI: 10.1177/0023677214556668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are no reported studies evaluating the effect of midazolam on recovery quality, recovery time or minimum alveolar concentration (MAC) at which extubation occurs (MAC extubation). Our hypotheses were that midazolam administered prior to recovery would decrease MAC extubation, prolong recovery time but provide a smoother recovery. Sixteen Yorkshire pigs were anesthetized with isoflurane for approximately 5 h. The end-tidal isoflurane concentration was then stabilized at 1.4% for 20 min. Pigs were randomly assigned to receive midazolam or saline. The vaporizer was decreased by 10% every 10 min until extubation. Pigs were declared awake by a blinded observer and were assigned a recovery score by the same observer. Mean MAC extubation was not significantly different for pigs receiving saline prior to recovery compared with those pigs receiving midazolam. The overall mean MAC extubation for both groups was 0.6 ± 0.4 vol%. Time to extubation was not significantly longer with midazolam (124 ± 36 min) compared with the saline group (96 ± 61 min; P = 0.09). Recovery score was not significantly different between groups (midazolam, 0.86 ± 1.1; saline 0.5 ± 0.5; P = 0.26). In conclusion, midazolam did not affect MAC extubation. There was no advantage of administering midazolam in the recovery period when performing step-down titration of isoflurane anesthesia.
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Affiliation(s)
- S A Kleine
- Department of Small Animal Medicine and Surgery
| | - J E Quandt
- Department of Small Animal Medicine and Surgery
| | | | - J Peroni
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
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Influence of progressive hemorrhage and subsequent cardiopulmonary resuscitation on the bispectral index during isoflurane anesthesia in a swine model. J Trauma Acute Care Surg 2012; 72:1614-9. [PMID: 22695430 DOI: 10.1097/ta.0b013e3182569e9c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The bispectral index for measurement of anesthetic depth may be modified by extreme hypotension during hemorrhagic shock. In this study, the influence of progressive hemorrhage and subsequent cardiopulmonary resuscitation on the bispectral index was investigated under controlled anesthetic depth. METHODS Fifteen swine were anesthetized through inhalation of isoflurane under bispectral index monitoring. Hemorrhagic shock was induced using a stepwise hemorrhage model in which 20%, 10%, and 10% of estimated blood volume were removed over three 30-minute periods and then 5% was removed every 30 minutes until the mean arterial pressure was less than 10 mm Hg. After reaching this criterion, chest compression with 0.2-mg/kg epinephrine and hydroxyethyl starch infusion was performed for 20 minutes or until the mean arterial pressure exceeded 50 mm Hg. The pharmacodynamics of the isoflurane effect was examined before hemorrhage, after 40% bleeding, and after resuscitation. RESULTS A mean (SD) volume of 836 (78) mL of blood was drained before resuscitation. The bispectral index suddenly decreased at a mean (SD) arterial pressure of 22 (3) mm Hg and showed isoelectric activity in most animals before resuscitation. Eight pigs were resuscitated, and the bispectral index recovered during a range of periods after recovery of the mean arterial pressure. The pharmacodynamic effect of isoflurane did not change after 40% bleeding but increased after resuscitation, with the alteration correlated with the time for resuscitation. CONCLUSION In hemorrhagic shock, the bispectral index merely reflects the anesthetic depth until development of lethal hypotension at which brain electrical activity cannot be sustained. After recovery from depression, the potency of isoflurane can increase depending on the cerebral hypoperfusion time. The increased bispectral index for anesthetics after resuscitation might reflect the degree of cerebral damage due to hypoperfusion.
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Larentzakis A, Toutouzas KG, Papalois A, Lapidakis G, Doulgerakis S, Doulami G, Drimousis P, Theodorou D, Katsaragakis S. Porcine model of hemorrhagic shock with microdialysis monitoring. J Surg Res 2012; 179:e177-82. [PMID: 22480841 DOI: 10.1016/j.jss.2012.01.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/23/2011] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A number of experimental protocols have been used to try to reproduce the clinical scenarios of hemorrhagic shock. The present study reports on an experimental swine model of controlled hemorrhagic shock that incorporates microdialysis monitoring for the evaluation of tissue perfusion and oxygenation. The aim of our study was to provide a reproducible, accurate, and reliable model for the testing and evaluation of therapeutic interventions in the area of hemorrhagic shock. METHODS Landrace swine (n = 8) were subjected to controlled hemorrhagic shock, with a mean arterial pressure of 35 ± 5 as the endpoint. Six more pigs were used as the control group. Microdialysis monitoring of the tissue lactate/pyruvate ratio was used. The mean arterial pressure, heart rate, hematocrit, hemoglobin, and lactate/pyruvate ratio measurements were obtained just before (phase A) and 30 min after (phase B) hemorrhage in the study group; the control group underwent the same measurements at the corresponding points. RESULTS The mean arterial pressure, hematocrit, and hemoglobin were lower (P < 0.05) in the study group than in the control group at phase B and compared with the values for the study group at phase A. Also, the lactate/pyruvate ratio and heart rate were greater (P < 0.05) in the study group than in control group at phase B and compared with the values for the study group at phase A. CONCLUSIONS This model of hemorrhagic shock is effective and correlates with the clinical parameters of tissue oxygenation, as documented by microdialysis.
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Affiliation(s)
- Andreas Larentzakis
- First Propaedeutic Surgical Clinic, Hippocratio Hospital, Athens Medical School, University of Athens, Athens, Greece.
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Kurita T, Takata K, Morita K, Uraoka M, Sato S. The Influence of Endotoxemia on the Electroencephalographic and Antinociceptive Effects of Isoflurane in a Swine Model. Anesth Analg 2010; 110:83-8. [DOI: 10.1213/ane.0b013e3181c22146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kurita T, Takata K, Morita K, Morishima Y, Uraoka M, Katoh T, Sato S. The Influence of Hemorrhagic Shock on the Electroencephalographic and Immobilizing Effects of Propofol in a Swine Model. Anesth Analg 2009; 109:398-404. [DOI: 10.1213/ane.0b013e3181a96f9a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
This paper is the thirtieth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2007 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia; stress and social status; tolerance and dependence; learning and memory; eating and drinking; alcohol and drugs of abuse; sexual activity and hormones, pregnancy, development and endocrinology; mental illness and mood; seizures and neurologic disorders; electrical-related activity and neurophysiology; general activity and locomotion; gastrointestinal, renal and hepatic functions; cardiovascular responses; respiration and thermoregulation; and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd.,Flushing, NY 11367, United States.
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