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Ju JW, Lee HJ, Nam K, Kim S, Hong H, Yoo SH, Lee S, Cho YJ, Jeon Y. Volatile Anesthetic Use Versus Total Intravenous Anesthesia for Patients Undergoing Heart Valve Surgery: A Nationwide Population-Based Study. Anesth Analg 2024; 139:114-123. [PMID: 38885399 DOI: 10.1213/ane.0000000000006760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Many studies have suggested that volatile anesthetic use may improve postoperative outcomes after cardiac surgery compared to total intravenous anesthesia (TIVA) owing to its potential cardioprotective effect. However, the results were inconclusive, and few studies have included patients undergoing heart valve surgery. METHODS This nationwide population-based study included all adult patients who underwent heart valve surgery between 2010 and 2019 in Korea based on data from a health insurance claim database. Patients were divided based on the use of volatile anesthetics: the volatile anesthetics or TIVA groups. After stabilized inverse probability of treatment weighting (IPTW), the association between the use of volatile anesthetics and the risk of cumulative 1-year all-cause mortality (the primary outcome) and cumulative long-term (beyond 1 year) mortality were assessed using Cox regression analysis. RESULTS Of the 30,755 patients included in this study, the overall incidence of 1-year mortality was 8.5%. After stabilized IPTW, the risk of cumulative 1-year mortality did not differ in the volatile anesthetics group compared to the TIVA group (hazard ratio, 0.98; 95% confidence interval, 0.90-1.07; P = .602), nor did the risk of cumulative long-term mortality (hazard ratio, 0.98; 95% confidence interval, 0.93-1.04; P = .579) at a median (interquartile range) follow-up duration of 4.8 (2.6-7.6) years. CONCLUSIONS Compared with TIVA, volatile anesthetic use was not associated with reduced postoperative mortality risk in patients undergoing heart valve surgery. Our findings indicate that the use of volatile anesthetics does not have a significant impact on mortality after heart valve surgery. Therefore, the choice of anesthesia type can be based on the anesthesiologists' or institutional preference and experience.
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Affiliation(s)
- Jae-Woo Ju
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Karam Nam
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Ho Yoo
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seohee Lee
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn Joung Cho
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunseok Jeon
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Wu JJ, Zhang TY, Qi YH, Zhu MY, Fang Y, Qi CJ, Cao LO, Lu JF, Lu BH, Tang LM, Shen JX, Mou S. Efficacy and safety of Yiqi Peiyuan granules for improving the short-term prognosis of patients with acute kidney injury: A multicenter, double-blind, placebo-controlled, randomized trial. JOURNAL OF INTEGRATIVE MEDICINE 2024; 22:279-285. [PMID: 38688809 DOI: 10.1016/j.joim.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/12/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Yiqi Peiyuan (YQPY) prescription, a composite prescription of traditional Chinese medicine, has been used to prevent or delay the continued deterioration of renal function after acute kidney injury (AKI) in some institutions and has shown considerable efficacy. OBJECTIVE This is the first randomized controlled trial to assess efficacy and safety of YQPY for improving short-term prognosis in adult patients with AKI. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This is a prospective, double-blind, multicenter, randomized, and placebo-controlled clinical trial. A total of 144 enrolled participants were randomly allocated to two groups according to a randomization schedule. Participants, caregivers and investigators assessing the outcomes were blinded to group assignment. Patients in the YQPY group received 36 g YQPY granules twice a day for 28 days. Patients in the placebo group received a placebo in the same dose as the YQPY granules. MAIN OUTCOME MEASURES The primary outcome was the change in the estimated glomerular filtration rate (eGFR) between baseline and after 4 and 24 weeks of treatment. The secondary outcomes were the change of serum creatinine (Scr) level between baseline and after treatment, and the incidence of endpoint events, defined as eGFR increasing by more than 25% above baseline, eGFR >75 mL/min per 1.73 m2 or the composite endpoint, which was defined as the sum of patients meeting either of the above criteria. RESULTS Data from a total of 114 patients (59 in the YQPY group and 55 in the control group) were analyzed. The mean changes in eGFR and Scr in weeks 4 and 24 had no difference between the two groups. In further subgroup analysis (22 in the YQPY group and 31 in the control group), the mean change in eGFR after treatment for 4 weeks was 27.39 mL/min per 1.73 m2 in the YQPY group and 5.78 mL/min per 1.73 m2 in the placebo group, and the mean difference between groups was 21.61 mL/min per 1.73 m2 (P < 0.001). Thirteen (59.1%) patients in the YQPY group and 5 (16.1%) in the placebo group reached the composite endpoints (P = 0.002). During the intervention, 2 and 4 severe adverse events were reported in the YQPY and placebo groups, respectively. CONCLUSION The YQPY granules can effectively improve the renal function of patients 4 weeks after the onset of AKI, indicating that it has good efficacy for improving short-term renal outcomes in patients with AKI. The YQPY granules may be a promising therapy for adults with AKI. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100051723. Please cite this article as: Wu JJ, Zhang TY, Qi YH, Zhu MY, Fang Y, Qi CJ, Cao LO, Lu JF, Lu BH, Tang LM, Shen JX, Mou S. Efficacy and safety of Yiqi Peiyuan granules for improving the short-term prognosis of patients with acute kidney injury: a multicenter, double-blind, placebo-controlled, randomized trial. J Integr Med. 2024; 22(3): 279-285.
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Affiliation(s)
- Jia-Jia Wu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Tian-Yi Zhang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Ying-Hui Qi
- Department of Nephrology, Shanghai Pudong New Area Punan Hospital, Shanghai 200125, China
| | - Min-Yan Zhu
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Yan Fang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Chao-Jun Qi
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Li-Ou Cao
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Ji-Fang Lu
- Department of Nephrology, Ningbo Hangzhou Bay Hospital, Ningbo 315336, Zhejiang Province, China
| | - Bo-Han Lu
- Department of Nephrology, Ningbo Hangzhou Bay Hospital, Ningbo 315336, Zhejiang Province, China
| | - Lu-Min Tang
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
| | - Jian-Xiao Shen
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
| | - Shan Mou
- Department of Nephrology, Molecular Cell Lab for Kidney Disease, Shanghai Peritoneal Dialysis Research Center, Uremia Diagnosis and Treatment Center, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
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Milne B, Gilbey T, Kunst G. Perioperative Management of the Patient at High-Risk for Cardiac Surgery-Associated Acute Kidney Injury. J Cardiothorac Vasc Anesth 2022; 36:4460-4482. [PMID: 36241503 DOI: 10.1053/j.jvca.2022.08.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is one of the most common major complications of cardiac surgery, and is associated with increased morbidity and mortality. Cardiac surgery-associated AKI has a complex, multifactorial etiology, including numerous factors such as primary cardiac dysfunction, hemodynamic derangements of cardiac surgery and cardiopulmonary bypass, and the possibility of a large volume of blood transfusion. There are no truly effective pharmacologic therapies for the management of AKI, and, therefore, anesthesiologists, intensivists, and cardiac surgeons must remain vigilant and attempt to minimize the risk of developing renal dysfunction. This narrative review describes the current state of the scientific literature concerning the specific aspects of cardiac surgery-associated AKI, and presents it in a chronological fashion to aid the perioperative clinician in their approach to this high-risk patient group. The evidence was considered for risk prediction models, preoperative optimization, and the intraoperative and postoperative management of cardiac surgery patients to improve renal outcomes.
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Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Tom Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; National Institute of Health Research Academic Clinical Fellow, King's College London, London, United Kingdom
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, United Kingdom; School of Cardiovascular Medicine and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, United Kingdom.
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Han J, Oh AY, Koo CH, Bae YK, Jeon YT. Effects of Anesthetic Technique on the Occurrence of Acute Kidney Injury after Spine Surgery: A Retrospective Cohort Study. J Clin Med 2021; 10:jcm10235653. [PMID: 34884355 PMCID: PMC8658142 DOI: 10.3390/jcm10235653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022] Open
Abstract
The effects of anesthetics on acute kidney injury (AKI) after spine surgery have not been evaluated fully. This study compared propofol-based total intravenous anesthesia (TIVA) and volatile anesthetics in the development of AKI after spine surgery. This retrospective study reviewed patients who underwent spine surgery between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for AKI. Additionally, after propensity score matching, the incidence of AKI was compared between TIVA and volatile groups. Of the 4473 patients, 709 were excluded and 3764 were included in the logistic regression. After propensity score matching, 766 patients from each group were compared, and we found that the incidence of AKI was significantly lower in the TIVA group (1% vs. 4.2%, p < 0.001). In the multivariate logistic regression analysis, the risk factors for postoperative AKI were male sex (OR 1.85, 95% CI 1.18–3.06), hypertension (OR 2.48, 95% CI 1.56–3.94), anemia (OR 2.66, 95% CI 1.76–4.04), and volatile anesthetics (OR 4.69, 95% CI 2.24–9.84). Compared with volatile anesthetics, TIVA is associated with a reduced risk of AKI for patients who have undergone spine surgery.
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Affiliation(s)
- Jiwon Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam-si 13620, Korea; (J.H.); (A.-Y.O.); (C.-H.K.); (Y.K.B.)
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam-si 13620, Korea; (J.H.); (A.-Y.O.); (C.-H.K.); (Y.K.B.)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam-si 13620, Korea; (J.H.); (A.-Y.O.); (C.-H.K.); (Y.K.B.)
| | - Yu Kyung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam-si 13620, Korea; (J.H.); (A.-Y.O.); (C.-H.K.); (Y.K.B.)
| | - Yong-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Gumi-ro, Bundang-gu, Seongnam-si 13620, Korea; (J.H.); (A.-Y.O.); (C.-H.K.); (Y.K.B.)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-31-787-7493
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Früh A, Bileck A, Muqaku B, Wurm R, Neuditschko B, Arfsten H, Galli L, Kriechbaumer L, Hubner P, Goliasch G, Heinz G, Holzer M, Sterz F, Adlbrecht C, Gerner C, Distelmaier K. Catalase Predicts In-Hospital Mortality after Out-of-Hospital Cardiac Arrest. J Clin Med 2021; 10:jcm10173906. [PMID: 34501367 PMCID: PMC8432041 DOI: 10.3390/jcm10173906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022] Open
Abstract
The generation of harmful reactive oxygen species (ROS), including hydrogen peroxide, in out-of-hospital cardiac arrest (OHCA) survivors causes systemic ischemia/reperfusion injury that may lead to multiple organ dysfunction and mortality. We hypothesized that the antioxidant enzyme catalase may attenuate these pathophysiological processes after cardiac arrest. Therefore, we aimed to analyze the predictive value of catalase levels for mortality in OHCA survivors. In a prospective, single-center study, catalase levels were determined in OHCA survivors 48 h after the return of spontaneous circulation. Thirty-day mortality was defined as the study end point. A total of 96 OHCA survivors were enrolled, of whom 26% (n = 25) died within the first 30 days after OHCA. The median plasma intensity levels (log2) of catalase were 8.25 (IQR 7.64–8.81). Plasma levels of catalase were found to be associated with mortality, with an adjusted HR of 2.13 (95% CI 1.07–4.23, p = 0.032). A Kaplan–Meier analysis showed a significant increase in 30-day mortality in patients with high catalase plasma levels compared to patients with low catalase levels (p = 0.012). High plasma levels of catalase are a strong and independent predictor for 30-day mortality in OHCA survivors. This indicates that ROS-dependent tissue damage is playing a crucial role in fatal outcomes of post-cardiac syndrome patients.
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Affiliation(s)
- Anton Früh
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Andrea Bileck
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Besnik Muqaku
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
| | - Raphael Wurm
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Benjamin Neuditschko
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Department of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
| | - Henrike Arfsten
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Galli
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Lukas Kriechbaumer
- University Clinic of Orthopedics, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
| | - Pia Hubner
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Gottfried Heinz
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
| | - Michael Holzer
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | - Fritz Sterz
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria; (P.H.); (M.H.); (F.S.)
| | | | - Christopher Gerner
- Department of Analytical Chemistry, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria; (A.B.); (B.M.); (B.N.)
- Joint Metabolome Facility, Faculty of Chemistry, University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (A.F.); (H.A.); (L.G.); (G.G.); (G.H.); (K.D.)
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Baseline Values and Kinetics of IL-6, Procalcitonin, and TNF- α in Landrace-Large White Swine Anesthetized with Propofol-Based Total Intravenous Anesthesia. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6672573. [PMID: 34250089 PMCID: PMC8238574 DOI: 10.1155/2021/6672573] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/01/2021] [Accepted: 05/22/2021] [Indexed: 01/01/2023]
Abstract
The baseline levels of various inflammatory mediators and their changes during anesthesia in swine are not known. The aim of this animal study was to measure the baseline values and kinetics of interleukin-6, procalcitonin, and tumor necrosis factor-alpha in healthy Landrace-Large White swine anesthetized with propofol-based total intravenous anesthesia. We included 8 healthy male pigs with an average weight of 19 ± 2 kg (aged 10-15 weeks) that were subjected to propofol-based total intravenous anesthesia for 8 hours. Complete blood count, serum chemistry, and serum levels of interleukin-6, procalcitonin, and tumor necrosis factor-alpha were analyzed, and serum levels were quantified hourly. Blood was also collected for bacterial culturing. Baseline values of interleukin-6 and procalcitonin were 18 pg/ml and 21 ng/ml, respectively, while tumor necrosis factor-alpha was not detectable during collection of baseline samples. A statistically significant difference was observed in interleukin-6 levels between time points (p < 0.0001). Procalcitonin increased with time, but there were no significant differences between time points (p = 0.152). Tumor necrosis factor-alpha increased until the 3rd hour of propofol-based total intravenous anesthesia, while after the 4th hour, it gradually decreased, reaching its baseline undetectable values by the 7th hour (p < 0.001). Our results can serve as the basis for further translational research.
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Carcy R, Cougnon M, Poet M, Durandy M, Sicard A, Counillon L, Blondeau N, Hauet T, Tauc M, F Pisani D. Targeting oxidative stress, a crucial challenge in renal transplantation outcome. Free Radic Biol Med 2021; 169:258-270. [PMID: 33892115 DOI: 10.1016/j.freeradbiomed.2021.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
Disorders characterized by ischemia/reperfusion (I/R) are the most common causes of debilitating diseases and death in stroke, cardiovascular ischemia, acute kidney injury or organ transplantation. In the latter example the I/R step defines both the amplitude of the damages to the graft and the functional recovery outcome. During transplantation the kidney is subjected to blood flow arrest followed by a sudden increase in oxygen supply at the time of reperfusion. This essential clinical protocol causes massive oxidative stress which is at the basis of cell death and tissue damage. The involvement of both reactive oxygen species (ROS) and nitric oxides (NO) has been shown to be a major cause of these cellular damages. In fact, in non-physiological situations, these species escape endogenous antioxidant control and dangerously accumulate in cells. In recent years, the objective has been to find clinical and pharmacological treatments to reduce or prevent the appearance of oxidative stress in ischemic pathologies. This is very relevant because, due to the increasing success of organ transplantation, clinicians are required to use limit organs, the preservation of which against oxidative stress is crucial for a better outcome. This review highlights the key actors in oxidative stress which could represent new pharmacological targets.
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Affiliation(s)
- Romain Carcy
- Université Côte d'Azur, CNRS, LP2M, Nice, France; CHU Nice, Hôpital Pasteur 2, Service de Réanimation Polyvalente et Service de Réanimation des Urgences Vitales, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Marc Cougnon
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Mallorie Poet
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Manon Durandy
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Antoine Sicard
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France; CHU Nice, Hôpital Pasteur 2, Service de Néphrologie-Dialyse-Transplantation, Nice, France; Clinical Research Unit of Université Côte d'Azur (UMR2CA), France
| | - Laurent Counillon
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | | | - Thierry Hauet
- Université de Poitiers, INSERM, IRTOMIT, CHU de Poitiers, La Milétrie, Poitiers, France
| | - Michel Tauc
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France
| | - Didier F Pisani
- Université Côte d'Azur, CNRS, LP2M, Nice, France; Laboratories of Excellence Ion Channel Science and Therapeutics, Nice, France.
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Sakata K, Kito K, Tanabe K, Fukuoka N, Nagase K, Iida H. Propofol But Not Desflurane Maintains Rat Cerebral Arteriolar Responses to Acetylcholine During Acute Hyperglycemia. J Neurosurg Anesthesiol 2021; 33:177-182. [PMID: 31306261 DOI: 10.1097/ana.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute hyperglycemia causes vascular endothelial dysfunction in various organs including the cerebral vessels. It is associated with increased mortality and morbidity in the perioperative period. The impact of anesthetic agents on cerebral vasodilatory responses during hyperglycemia remains unclear. We investigated endothelial function in rat cerebral arterioles during acute hyperglycemia, under propofol or desflurane anesthesia. MATERIALS AND METHODS A closed cranial window preparation was used to measure changes in pial arteriole diameter induced by topical application of acetylcholine (ACh), an endothelium-dependent vasodilator, in rats anesthetized with propofol or desflurane. Pial arteriole responses to ACh were measured during normoglycemia and hyperglycemia. We then investigated whether the response of cerebral arterioles to acute hyperglycemia under propofol anesthesia were related to propofol or its vehicle, intralipid. RESULTS ACh resulted in a dose-dependent dilation of cerebral arterioles during propofol and desflurane anesthesia under normoglycemic conditions. The vasodilatory effects of ACh were also maintained under hyperglycemic conditions during propofol anesthesia, but the vasodilator response to ACh was significantly impaired during hyperglycemia compared with normoglycemia with desflurane anesthesia. The vasodilatory effects of ACh were maintained during normoglycemia and hyperglycemia in rats receiving propofol or intralipid. CONCLUSIONS Rat pial arteriole responses to ACh are maintained during conditions of acute hyperglycemia with propofol anesthesia but suppressed compared with normoglycemia with desflurane anesthesia.
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Affiliation(s)
- Koji Sakata
- Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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The impact of total intravenous anesthesia versus inhalation anesthesia on acute kidney injury after major abdominal surgery: a propensity score analysis. J Anesth 2021; 35:112-121. [PMID: 33389161 DOI: 10.1007/s00540-020-02882-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE The effect of anesthetic types on postoperative acute kidney injury (AKI) remains unclear particularly in patients undergoing non-cardiac surgery. The purpose of this retrospective study was to compare total intravenous anesthesia (TIVA) and inhalation anesthesia in terms of the risk of AKI after open major abdominal surgery (MAS). METHODS Adult patients who underwent open MAS (gastrectomy, hepatectomy, colectomy, or pancreatectomy) at our institute from 2016 to 2018 were included. Using the multivariable logistic regression, the risk of postoperative AKI was compared among patients who underwent TIVA (TIVA group) and inhalation anesthesia (inhalation group) both in the total cohort and in the propensity score-matched cohort. Additional multivariable logistic regression analysis was performed with inverse probability of treatment weighting (IPTW) using the propensity score. RESULTS In total, 3616 patients were analyzed. The incidence of postoperative AKI was 5.0% (77/1546) and 7.8% (161/2070) in the TIVA and inhalation groups, respectively. The risk of AKI was significantly higher in the inhalation group [adjusted odds ratio (aOR) 1.72; 95% confidence interval (CI) 1.27-2.35; P = 0.002] than the TIVA group. In the matched cohort (n = 1518 in each group), the inhalation group also had a higher risk of AKI (aOR 1.66; 95% CI 1.20-2.31; P = 0.002). The multivariable logistic regression with IPTW showed similar results (aOR 1.59; 95% CI 1.30-1.95; P < 0.001). CONCLUSIONS The risk of AKI after open MAS differed significantly according to the anesthetic used. Patients receiving inhalation anesthesia may have a greater risk of postoperative AKI than those undergoing TIVA.
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Jose RL, Damayanathi D, Unnikrishnan KP, Suneel PR. A comparison of sevoflurane versus sevoflurane-propofol combination on renal function in patients undergoing valvular heart surgery-A prospective randomized controlled pilot study. Ann Card Anaesth 2021; 24:172-177. [PMID: 33884972 PMCID: PMC8253025 DOI: 10.4103/aca.aca_171_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim The objective of the present study was to compare the effect of sevoflurane with the sevoflurane-propofol combination on renal function in patients undergoing valvular heart surgery. The renal protective effect was assessed using a novel marker called neutrophil gelatinase-associated lipocalin (NGAL). Materials and Methods This was a prospective randomized controlled pilot study conducted at a tertiary care center in India. The study enrolled 36 patients undergoing elective valvular heart surgery, but only 31 were included. All the patients were randomized into two groups, that is, 15 in the sevoflurane group (S-group) and 16 in the sevoflurane-propofol group (SP-group). The baseline NGAL level and test NGAL level at 4 h after cardiopulmonary bypass were measured. Results There was a significant rise in the test NGAL levels compared to baseline in both the groups. The test NGAL level in the S-group was significantly high compared to that of the SP-group (P = 0.034). The number of patients with acute kidney injury was less in the SP-group without reaching statistical significance (P = 0.210). Conclusion Renal function was better preserved in patients anesthetized with a combination of sevoflurane and propofol. This could be due to the enhanced protective effect on renal function by both sevoflurane and propofol.
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Affiliation(s)
- Reshmi L Jose
- Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Deepa Damayanathi
- Department of Biochemistry, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Koniaparambil P Unnikrishnan
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Puthuvassery R Suneel
- Department of Cardiothoracic and Vascular Anaesthesia, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Abstract
Renal diseases remain devastating illnesses with unacceptably high rates of mortality and morbidity worldwide. Animal models are essential tools to better understand the pathomechanism of kidney-related illnesses and to develop new, successful therapeutic strategies. Magnetic resonance imaging (MRI) has been actively explored in the last decades for assessing renal function, perfusion, tissue oxygenation as well as the degree of fibrosis and inflammation. This chapter aims to provide an overview of the preparation and monitoring of small animals before, during, and after surgical interventions or MR imaging. Standardization of experimental settings such as body temperature or hydration of animals and minimizing pain and distress are essential for diminishing nonexperimental variables as well as for conducting ethical research.This publication is based upon work from the COST Action PARENCHIMA, a community-driven network funded by the European Cooperation in Science and Technology (COST) program of the European Union, which aims to improve the reproducibility and standardization of renal MRI biomarkers.
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Guinot PG, Ellouze O, Grosjean S, Berthoud V, Constandache T, Radhouani M, Anciaux JB, Aho-Glele S, Morgant MC, Girard C, Nguyen M, Bouhemad B. Anaesthesia and ICU sedation with sevoflurane do not reduce myocardial injury in patients undergoing cardiac surgery: A randomized prospective study. Medicine (Baltimore) 2020; 99:e23253. [PMID: 33327246 PMCID: PMC7738139 DOI: 10.1097/md.0000000000023253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To evaluate the effect of anaesthesia and ICU sedation with sevoflurane to protect the myocardium against ischemia-reperfusion injury associated to cardiac surgery assessed by troponin release. METHODS We performed a prospective, open-label, randomized study in cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group and a control group. The main outcome was the perioperative kinetic of cardiac troponin I (cTnI). The secondary outcomes included composite endpoint, GDF-15 (macrophage inhibitory cytokine-1) value, arterial lactate levels, and the length of stay (LOS) in the ICU. RESULTS Of 82 included patients, 81 were analyzed on an intention-to-treat basis (intervention group: n = 42; control group: n = 39). On inclusion, the intervention and control groups did not differ significantly in terms of demographic and surgical data. The postoperative kinetics of cTnI did not differ significantly between groups: the mean difference was 0.44 ± 1.09 μg/ml, P = .69. Incidence of composite endpoint and GDF-15 values were higher in the sevoflurane group than in propofol group. The intervention and control groups did not differ significantly in terms of ICU stay and hospital stay. CONCLUSION The use of an anaesthesia and ICU sedation with sevoflurane was not associated with a lower incidence of myocardial injury assessed by cTnI. Sevoflurane administration was associated with higher prevalence of acute renal failure and higher GDF-15 values.
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Affiliation(s)
- Pierre-Grégoire Guinot
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
- Université Bourgogne Franche-Comté, LNC UMR866
| | - Omar Ellouze
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Sandrine Grosjean
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Vivien Berthoud
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Tiberiu Constandache
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Mohamed Radhouani
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Jean-Baptiste Anciaux
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | | | | | - Claude Girard
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Maxime Nguyen
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
| | - Belaid Bouhemad
- Department of Anesthesiology and Critical Care Medicine, Dijon University Medical Center
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Park J, Lee SH, Lee JH, Min JJ, Kwon JH, Oh AR, Carriere K, Ahn J. Volatile versus total intravenous anesthesia for 30-day mortality following non-cardiac surgery in patients with preoperative myocardial injury. PLoS One 2020; 15:e0238661. [PMID: 32915840 PMCID: PMC7485855 DOI: 10.1371/journal.pone.0238661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022] Open
Abstract
We evaluated whether volatile anesthetics can improve the postoperative outcomes of non-cardiac surgery in patients with preoperative myocardial injury defined by the cardiac troponin elevation. From January 2010 to June 2018, 1254 adult patients with preoperative myocardial injury underwent non-cardiac surgery under general anesthesia and were enrolled in this study. Patients were stratified into following two groups according to anesthetic agents; 115 (9.2%) patients whose anesthesia was induced and maintained with continuous infusion of propofol and remifentanil (TIVA group) and 1139 (90.8%) patients whose anesthesia was maintainted with volatile anesthetics (VOLATILE group). The primary outcome was 30-day mortality. To diminish the remifentanil effect, a further analysis was conducted after excluding the patients who received only volatile anesthetics without remifentanil infusion. In a propensity-score matched analysis, 30-day mortality was higher in the TIVA group than the VOLATILE group (17.0% vs. 9.1%; hazard ratio [HR] 2.60; 95% confidence interval [CI], 1.14-5.93; p = 0.02). In addition, the TIVA group showed higher 30-day mortality than the VOLATILE group, even after eliminating the effect of remifentanil infusion (15.8% vs. 8.3%; HR 4.62; 95% CI, 1.82-11.74; p = 0.001). In our study, the use of volatile anesthetics showed the significant survival improvement after non-cardiac surgery in patients with preoperative myocardial injury, which appears to be irrelevant to the remifentanil use. Further studies are needed to confirm this beneficial effect of volatile anesthetics. Clinical trial number and registry URL: KCT0004349 (www.cris.nih.go.kr).
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Affiliation(s)
- Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hwa Lee
- Department of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ah-ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keumhee Carriere
- Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Joonghyun Ahn
- Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Oh SK, Lim BG, Kim YS, Kim SS. Comparison of the Postoperative Liver Function Between Total Intravenous Anesthesia and Inhalation Anesthesia in Patients with Preoperatively Elevated Liver Transaminase Levels: A Retrospective Cohort Study. Ther Clin Risk Manag 2020; 16:223-232. [PMID: 32308400 PMCID: PMC7147612 DOI: 10.2147/tcrm.s248441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background Anesthesia and surgery may deteriorate liver function in patients with elevated liver enzyme levels; therefore, in these patients, choosing anesthetics with less hepatotoxicity is important. Methods This retrospective study investigated the effect of total intravenous anesthesia (TIVA) versus inhalation anesthesia (INHA) on the postoperative liver function in patients with preoperatively elevated liver enzyme levels (aspartate transaminase [AST] or alanine transaminase [ALT] >40 U/L) who underwent non-hepatic surgery under general anesthesia. We compared the changes in enzyme levels within 24 hrs before and after surgery. Results In 730 patients (TIVA: n=138; INHA: n=592), the baseline characteristics were comparable, except for higher comorbidity rates in the TIVA group. The median anesthesia and operation times were significantly longer in the TIVA group because approximately 50% of the TIVA group (vs 19.7% of the INHA group) underwent neurosurgery, which had a relatively longer operation time than other surgeries. Intraoperative hypotensive events and vasopressor use were more frequent in the TIVA group. After 1:4 propensity score matching (TIVA: n=94; INHA: n=376), the baseline characteristics and surgical variables were comparable, except for longer anesthesia time. Before matching, postoperative AST and ALT changes were significantly lower in the TIVA group than in the INHA group. After matching, only the ALT change was significantly lower after TIVA than after INHA [median (interquartile range), -16.7 (-32 to -4) % vs -12.0 (-28.6-6.5) %, P=0.025]. Conclusion TIVA may be safer for patients with preoperatively elevated liver transaminase levels.
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Affiliation(s)
- Seok Kyeong Oh
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung Gun Lim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Sung Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong Shin Kim
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Liu M, Li M, Zhou Y, Zhou Q, Jiang Y. HSP90 inhibitor 17AAG attenuates sevoflurane-induced neurotoxicity in rats and human neuroglioma cells via induction of HSP70. J Transl Med 2020; 18:166. [PMID: 32293462 PMCID: PMC7158111 DOI: 10.1186/s12967-020-02332-w] [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: 09/10/2019] [Accepted: 04/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background 17AAG has been extensively studied for its antitumor effects that protect cells from lethal stress by maintaining protein stability. The role of 17AAG in sevoflurane-induced neuronal injury has never been studied. We aim to investigate the effect of 17AAG on sevoflurane-induced neurotoxicity in vivo and in vitro. Methods Sevoflurane-induced hippocampal neuron injury model was established in aged Sprague–Dawley rats. Pretreatment of vehicle or 17AAG was administered prior to sevoflurane inhalation. H4 neuroglioma cells were pretreated with vehicle or 17AAG and exposed to sevoflurane. Apoptosis, oxidative stress, expression of interleukin-6 (IL-6), and activation of the nuclear factor-κB (NF-κB) signaling pathway in H4 cells were examined by Hoechst assay, flow cytometry, Western blot, and immunofluorescent staining. RNA interference against HSPA1A was performed to test the function of HSP70 in neuroprotection. Results Exogenous 17AAG reduced sevoflurane-induced apoptosis and oxidative stress in rat hippocampal neurons and in H4 cells. In H4 cells, 17AAG suppressed sevoflurane-induced upregulation of IL-6 and activation of NF-κB signaling. 17AAG enhanced sevoflurane-induced upregulation of HSP70 in rat hippocampal neurons and in H4 cells. Conversely, silencing of HSPA1A in H4 cells blocked the cytoprotective effect of 17AAG against sevoflurane-induced apoptosis and oxidative stress, and prevented upregulation of IL-6 and activation of NF-κB signaling. Conclusions 17AAG protects against sevoflurane-induced neurotoxicity in vivo and in vitro via HSP70-dependent inhibition of apoptosis, oxidative stress, and pro-inflammatory signaling pathway.
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Affiliation(s)
- Min Liu
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, No. 139, Changsha City, 410000, Hunan Province, People's Republic of China
| | - Moyun Li
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha City, 410000, Hunan Province, People's Republic of China
| | - Yu Zhou
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, No. 139, Changsha City, 410000, Hunan Province, People's Republic of China
| | - Qian Zhou
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, No. 139, Changsha City, 410000, Hunan Province, People's Republic of China
| | - Yugang Jiang
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, No. 139, Changsha City, 410000, Hunan Province, People's Republic of China.
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Koo BW, Lim DJ, Oh AY, Na HS. Retrospective Comparison between the Effects of Propofol and Inhalation Anesthetics on Postoperative Recurrence of Early- and Intermediate-Stage Hepatocellular Carcinoma. Med Princ Pract 2020; 29:422-428. [PMID: 32074612 PMCID: PMC7511682 DOI: 10.1159/000506637] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Previous studies have reported that propofol has antitumor, anti-inflammatory, and antioxidant effects in addition to its anesthetic properties. To confirm this, a retrospective investigation was conducted to determine whether different anesthetic agents, particularly propofol and inhalation anesthetics, have an effect on the recurrence of hepatocellular carcinoma (HCC) in patients who were diagnosed with primary HCC and underwent laparoscopic hepatectomy. SUBJECTS AND METHODS Patients with Barcelona Clinic Liver Cancer stages 0, A, and B HCC, who underwent laparoscopic hepatic resection, were enrolled in this study. Post-operative HCC recurrence, which was determined from postoperative liver CT, was evaluated 24 months postoperatively with respect to the main anesthetic agents. The characteristics of HCC and other patient-related or surgery-related variables were evaluated together. RESULTS AND CONCLUSION During the 24-month period after hepatic resection, less HCC patients in the propofol group than in the inhalation group recurred (p = 0.046). The mean time to recurrence was 20.8 months (95% CI, 19.7-22.0) and 19.1 months (95% CI, 17.8-20.4) in the propofol group and the inhalation group, respectively. In addition, multivariable Cox proportional regression analysis revealed that the propofol group showed significantly decreased recurrence versus the inhalation group (hazard ratio, 0.57; 95% CI, 0.47-0.69; p = 0.029). When propofol was used as the main general anesthetic agent for laparoscopic hepatic resection, the postoperative 2-year recurrence rate decreased in early- and intermediate-stage HCC.
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Affiliation(s)
- Bon-Wook Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dae-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ah-Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea,
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Effects of Volatile versus Total Intravenous Anesthesia on Occurrence of Myocardial Injury after Non-Cardiac Surgery. J Clin Med 2019; 8:jcm8111999. [PMID: 31731805 PMCID: PMC6912591 DOI: 10.3390/jcm8111999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 12/23/2022] Open
Abstract
The cardioprotective effects of volatile anesthetics versus total intravenous anesthesia (TIVA) are controversial, especially in patients undergoing non-cardiac surgery. Using current generation high-sensitivity cardiac troponin (hs-cTn), we aimed to evaluate the effect of anesthetics on the occurrence of myocardial injury after non-cardiac surgery (MINS). From February 2010 to December 2016, 3555 patients without preoperative hs-cTn elevation underwent non-cardiac surgery under general anesthesia. Patients were grouped according to anesthetic agent; 659 patients were classified into a propofol-remifentanil total intravenous anesthesia (TIVA) group, and 2896 patients were classified into a volatile group. To balance the use of remifentanil between groups, a balanced group (n = 1622) was generated with patients who received remifentanil infusion in the volatile group, and two separate comparisons were performed (TIVA vs. volatile and TIVA vs. balanced). The primary outcome was occurrence of MINS, defined as rise of hs-cTn I ≥ 0.04 ng/mL within postoperative 48 hours. The secondary outcomes were 30-day mortality, postoperative acute kidney injury (AKI), and adverse events during hospital stay (mortality, type I myocardial infarction (MI), and new-onset arrhythmia). In propensity-matched analyses, the occurrence of MINS was lower in the TIVA group compared to the volatile group (OR 0.642; 95% CI 0.450–0.914; p = 0.014). However, after balancing the use of remifentanil, there was no difference between groups in the risk of MINS (OR 0.832; 95% CI 0.554–1.251; p-value = 0.377). There were no significant associations between the two groups in type 1 MI, new-onset atrial fibrillation, in-hospital and 30-day mortality before and after balancing the use of remifentanil. However, the incidence of postoperative AKI was lower in the TIVA group (OR 0.362; 95% CI 0.194–0.675; p-value = 0.001). After balancing the use of remifentanil, volatile anesthesia and TIVA showed comparable effects on MINS in patients undergoing non-cardiac surgery without preoperative myocardial injury. Further studies are needed on the benefit of remifentanil infusion.
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General Anesthetic Agents and Renal Function after Nephrectomy. J Clin Med 2019; 8:jcm8101530. [PMID: 31554223 PMCID: PMC6832234 DOI: 10.3390/jcm8101530] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 02/06/2023] Open
Abstract
The association between the choice of general anesthetic agents and the risk of acute kidney injury (AKI) and long-term renal dysfunction after nephrectomy has not yet been evaluated. We reviewed 1087 cases of partial or radical nephrectomy. The incidence of postoperative AKI, new-onset chronic kidney disease (CKD) and CKD upstaging were compared between general anesthetic agent groups (propofol, sevoflurane, and desflurane). Four different propensity score analyses were performed to minimize confounding for each pair of comparison (propofol vs. sevoflurane; propofol vs. desflurane; sevoflurane vs. desflurane; propofol vs. volatile agents). Study outcomes were compared before and after matching. Kaplan-Meier survival curve analysis was performed to compare renal survival determined by the development of new-onset CKD between groups up to 36 months after nephrectomy. Propofol was associated with a lower incidence of AKI (propofol 23.2% vs. sevoflurane 39.5%, p = 0.004; vs. propofol 21.0% vs. desflurane 34.3%, p = 0.031), a lower incidence of CKD upstaging (propofol 27.2% vs. sevoflurane 58.4%, p < 0.001; propofol 32.4% vs. desflurane 48.6%, p = 0.017) and better three-year renal survival after nephrectomy compared to sevoflurane or desflurane group (Log-rank test propofol vs. sevoflurane p < 0.001; vs. desflurane p = 0.015) after matching. Propofol was also associated with a lower incidence of new-onset CKD after nephrectomy compared to sevoflurane after matching (p < 0.001). There were no significant differences between sevoflurane and desflurane. However, subgroup analysis of partial nephrectomy showed a significant difference only in CKD upstaging. In conclusion, propofol, compared to volatile agents, could be a better general anesthetic agent for nephrectomy to attenuate postoperative renal dysfunction. However, limitations of the retrospective study design and inconsistent results of the subgroup analysis preclude firm conclusions.
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Effect of sevoflurane-based or propofol-based anaesthesia on the incidence of postoperative acute kidney injury. Eur J Anaesthesiol 2019; 36:649-655. [DOI: 10.1097/eja.0000000000001020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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20
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The Binding Mechanisms and Inhibitory Effect of Intravenous Anesthetics on AChE In Vitro and In Vivo: Kinetic Analysis and Molecular Docking. Neurochem Res 2019; 44:2147-2155. [DOI: 10.1007/s11064-019-02852-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/25/2019] [Accepted: 07/29/2019] [Indexed: 01/23/2023]
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Propofol can suppress renal ischemia-reperfusion injury through the activation of PI3K/AKT/mTOR signal pathway. Gene 2019; 708:14-20. [DOI: 10.1016/j.gene.2019.05.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/04/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
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Abstract
The care of patients with acute kidney injury (AKI) has been limited due to the lack of effective therapeutics that can either prevent AKI during high-risk situations or treat AKI once established. A revolution in the scientific understanding of the pathogenesis of AKI has led to the identification of potential therapeutic targets. These targets include pathways involved in inflammation, cellular repair and fibrosis, cellular metabolism and mitochondrial function, oxidative stress, apoptosis, and hemodynamics and oxygen delivery. Many compounds are entering early-phase clinical trials. In addition, efforts to better describe sub-categories of AKI (through endo-phenotyping) hold promise to target therapies more effectively based upon pathways that are operative in the pathogenesis. These advances bring optimism that the care of patients with AKI will be transformed with the hope of better outcomes.
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Affiliation(s)
- Matthew Hulse
- Divison of Critical Care, Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, 22908, USA
| | - Mitchell H Rosner
- Division of Nephrology, Department of Medicine, University of Virginia Health System, 135 Hospital Drive, Suite 1031, Charlottesville, VA, 22908, USA.
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Zhao Y, Ai Y. Overexpression of lncRNA Gm15621 alleviates apoptosis and inflammation response resulting from sevoflurane treatment through inhibiting miR-133a/Sox4. J Cell Physiol 2019; 235:957-965. [PMID: 31264218 DOI: 10.1002/jcp.29011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 05/28/2019] [Indexed: 12/20/2022]
Abstract
Sevoflurane is the most widely used anesthetic administered by inhalation. Exposure to sevoflurane can elicit learning deficits and abnormal cognitive disorder. In this study, we investigated the function of long noncoding RNA (lncRNA) Gm15621. Primary hippocampal neuron cells were used to analyze the function of lncRNA Gm15621 in vitro. The tunel, inflammation markers, and cell survival rates were detected to evaluate the function of lncRNA Gm15621. Dual-luciferase reporter assay was used to identify the interaction between microRNA 133a and Gm15621. We found that lncRNA Gm15621 located in the cytoplasm. The expression of lncRNA Gm15621 was decreased with the development of sevoflurane exposure. Overexpression of lncRNA Gm15621 significantly reduced the apoptosis and cell survival rates. The inflammation response was also attenuated in lncRNA Gm15621 overexpressed group. The dual-luciferase assay revealed that miR-133a was the direct target of lncRNA Gm15621. In addition, we also found that Sox4 was a downstream target of miR-133a and lncRNA Gm15621 exerted its biological functions by regulating the expression of Sox4. In summary, our findings revealed that lncRNA Gm15621 ameliorated the sevoflurane-induced neurotoxicity and the important role of Gm15621/miR-133a/Sox4 axis in cognitive disorder.
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Affiliation(s)
- Yanling Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanqiu Ai
- Department of Anesthesiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Dadas A, Janigro D. Breakdown of blood brain barrier as a mechanism of post-traumatic epilepsy. Neurobiol Dis 2018; 123:20-26. [PMID: 30030025 DOI: 10.1016/j.nbd.2018.06.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/15/2018] [Accepted: 06/28/2018] [Indexed: 12/31/2022] Open
Abstract
Traumatic brain injury (TBI) accounts for approximately 16% of acute symptomatic seizures which usually occur in the first week after trauma. Children are at higher risk for post-traumatic seizures than adults. Post-traumatic seizures are a risk factor for delayed development of epilepsy. Delayed, chronic post-traumatic epilepsy is preceded by a silent period during which therapeutic interventions may arrest, revert or prevent epileptogenesis. A number of recent review articles summarize the most important features of post-traumatic seizures and epilepsy; this review will instead focus on the link between cerebrovascular permeability, epileptogenesis and ictal events after TBI. The possibility of acting on the blood-brain barrier (BBB) and the neurovascular unit to prevent, disrupt or treat post-traumatic epilepsy is also discussed. Finally, we describe the latest quest for biomarkers of epileptogenesis which may allow for a more targeted intervention.
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Affiliation(s)
- Aaron Dadas
- Department of Physiology, Case Western Reserve University, Cleveland, OH, United States
| | - Damir Janigro
- Department of Physiology, Case Western Reserve University, Cleveland, OH, United States; FloTBI Inc., 4415 Euclid Ave., Cleveland, OH, United States.
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Zhang GH, Wang W. Effects of sevoflurane and propofol on the development of pneumonia after esophagectomy: a retrospective cohort study. BMC Anesthesiol 2017; 17:164. [PMID: 29202701 PMCID: PMC5715630 DOI: 10.1186/s12871-017-0458-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/24/2017] [Indexed: 12/01/2022] Open
Abstract
Background Postoperative pneumonia (PP) is one of the common complications following esophagectomy and associated with poor short- and long-term outcomes. Sevoflurane and propofol, which have inflammatory-modulating effects, are common used general anesthetics. This study aimed to compare the effects of anesthesia with sevoflurane and propofol on the development of PP after esophageal surgery for cancer. Methods The electronic medical records of patients who underwent elective esophagectomy between July 2013 and July 2016 were reviewed. We conducted univariate and multivariate logistics analysis and propensity score matching analysis to compare the effect of sevoflurane and propofol on the incidence of PP and to identify the risk factors for PP after esophagectomy. Results Overall, the incidence of postoperative pneumonia was 9.5%. There was no significant difference in the rates of PP between sevoflurane group and propofol group either before or after propensity score matching (9.6% vs 8.0%, P = 0.606; 7.7% vs 6.4%, P = 0.754, respectively). Univariate and multivariate analysis revealed that alcohol use (OR 1.513; 95% CI 1.062–2.156), surgical procedure (Sweet: referent; Ivor-Lewis: OR 1.993; 95% CI 1.190–3.337; Three-incision: OR 1.878; 95% CI 1.296–2.722) and surgeon experience (high-volume: referent; low-volume: OR 1.525; 95% CI 1.090–2.135) were significant risk factors of postoperative pneumonia. Conclusions Sevoflurane did not differ from propofol in terms of affecting the risk of PP development after esophagectomy.
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Affiliation(s)
- Guo-Hua Zhang
- Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli Road, Chaoyang District, Beijing, 100021, China.
| | - Wen Wang
- Department of Anesthesiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuannanli Road, Chaoyang District, Beijing, 100021, China
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Motayagheni N, Phan S, Eshraghi C, Nozari A, Atala A. A Review of Anesthetic Effects on Renal Function: Potential Organ Protection. Am J Nephrol 2017; 46:380-389. [PMID: 29131005 DOI: 10.1159/000482014] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence. SUMMARY The effects of anesthetic drugs on renal failure are particularly important in the context of kidney transplantation, since the conditions of preservation following removal profoundly influence the recovery of organ function. Currently, preservation procedures are typically based on the usage of a cold-storage solution. Some anesthetic drugs induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. A more thorough understanding of anesthetic effects on renal function can present a novel approach for developing organ-protective strategies. The aim of this review is to discuss the effects of different anesthetic drugs on renal function, with particular focus on IR injury. Many studies have demonstrated the organ-protective effects of some anesthetic drugs, specifically propofol, which indicate the potential of some anesthetics to introduce novel organ protective targets. This is not surprising, since lipid emulsions are major components of propofol, which accumulating data show provide organ protective effects against IR injury. Key Messages: Thorough understanding of the interaction between anesthetic drugs and renal function remains fundamental to the delivery of safe perioperative care and to optimizing outcomes after renal surgeries, particularly transplant procedures. Anesthetics can be repurposed for organ protection with more information about their effects, especially during transplant procedures. Here, we review the effects of different anesthetic drugs - specifically those that contain lipids in their structure, with special reference to IR injury.
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Affiliation(s)
- Negar Motayagheni
- Institute for Regenerative Medicine (Wake Forest Institute of Regenerative Medicine), Wake Forest School of Medicine Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Sheshanna Phan
- Department of Anesthesiology, Division of Molecular Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Crystal Eshraghi
- Department of Anesthesiology, Division of Molecular Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Ala Nozari
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Atala
- Institute of Regenerative Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Chen H, Busse LW. Novel Therapies for Acute Kidney Injury. Kidney Int Rep 2017; 2:785-799. [PMID: 29270486 PMCID: PMC5733745 DOI: 10.1016/j.ekir.2017.06.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022] Open
Abstract
Acute kidney injury (AKI) is a common disease with a complex pathophysiology. The old paradigm of identifying renal injury based on location-prerenal, intrarenal, and postrenal-is now being supplanted with a new paradigm based on observable kidney injury patterns. The pathophysiology of AKI on a molecular and microanatomical level includes inflammation, immune dysregulation, oxidative injury, and impaired microcirculation. Treatment has traditionally been supportive, including the avoidance of nephrotoxins, judicious volume and blood pressure management, hemodynamic monitoring, and renal replacement therapy. Fluid overload and chloride-rich fluids are now implicated in the development of AKI, and resuscitation with a balanced, buffered solution at a conservative rate will mitigate risk. Novel therapies, which address specific observable kidney injury patterns include direct oxygen-free radical scavengers such as α-lipoic acid, curcumin, sodium-2-mercaptoethane sulphonate, propofol, and selenium. In addition, angiotensin II and adenosine receptor antagonists hope to ameliorate kidney injury via manipulation of renal hemodynamics and tubulo-glomerular feedback. Alkaline phosphatase, sphingosine 1 phosphate analogues, and dipeptidylpeptidase-4 inhibitors counteract kidney injury via manipulation of inflammatory pathways. Finally, genetic modifiers such as 5INP may mitigate AKI via transcriptive processes.
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Affiliation(s)
- Huaizhen Chen
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laurence William Busse
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Bang JY, Lee J, Oh J, Song JG, Hwang GS. The Influence of Propofol and Sevoflurane on Acute Kidney Injury After Colorectal Surgery. Anesth Analg 2016; 123:363-70. [DOI: 10.1213/ane.0000000000001274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ammar AS, Mahmoud KM. Comparative effect of propofol versus sevoflurane on renal ischemia/reperfusion injury after elective open abdominal aortic aneurysm repair. Saudi J Anaesth 2016; 10:301-7. [PMID: 27375385 PMCID: PMC4916814 DOI: 10.4103/1658-354x.174907] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Renal injury is a common cause of morbidity and mortality after elective abdominal aortic aneurysm (AAA) repair. Propofol has been reported to protect several organs from ischemia/reperfusion (I/R) induced injury. We performed a randomized clinical trial to compare propofol and sevoflurane for their effects on renal I/R injury in patients undergoing elective AAA repair. MATERIALS AND METHODS Fifty patients scheduled for elective AAA repair were randomized to receive propofol anesthesia in group I or sevoflurane anesthesia in group II. Urinary specific kidney proteins (N-acetyl-beta-glucosamidase, alpha-1-microglobulin, glutathione transferase [GST]-pi, GST-alpha) were measured within 5 min of starting anesthesia as a base line (T0), at the end of surgery (T1), 8 h after surgery (T2), 16 h after surgery (T3), and 24 h postoperatively (T4). Serum pro-inflammatory cytokines (tumor necrosis factor-α and interleukin 1-β) were measured at the same time points. In addition, serum creatinine and cystatin C were measured before starting surgery as a baseline and at days 1, 3, and 6 after surgery. RESULTS Postoperative urinary concentrations of all measured kidney specific proteins and serum pro-inflammatory cytokines were significantly lower in the propofol group. In addition, the serum creatinine and cystatin C were significantly lower in the propofol group compared with the sevoflurane group. CONCLUSION Propofol significantly reduced renal injury after elective open AAA repair and this could have clinical implications in situations of expected renal I/R injury.
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Affiliation(s)
- A S Ammar
- Department of Anesthesiology, Minoufiya Faculty of Medicine, Minoufiya University, Egypt
| | - K M Mahmoud
- Department of Anesthesiology, Minoufiya Faculty of Medicine, Minoufiya University, Egypt
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Min JJ, Kim G, Lee JH, Hong KY, Kim WS, Lee YT. Does the Type of Anesthetic Technique Affect In-Hospital and One-Year Outcomes after Off-Pump Coronary Arterial Bypass Surgery? PLoS One 2016; 11:e0152060. [PMID: 27054364 PMCID: PMC4824512 DOI: 10.1371/journal.pone.0152060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 03/09/2016] [Indexed: 01/21/2023] Open
Abstract
Despite numerous previous studies, there is little data on the effects of anesthetics on clinical outcome after off-pump coronary arterial bypass grafting (OPCAB). Therefore, we retrospectively compared the effects of anesthetic choice on in-hospital major adverse events (MAEs) and one-year major adverse cardiovascular and cerebral events (MACCEs) in patients undergoing OPCAB. Electronic medical records were reviewed in 192 patients who received propofol-remifenanil total intravenous anesthesia (TIVA) and propensity score-matched 662 patients who received isoflurane anesthesia. The primary endpoints were in-hospital MAEs and one-year MACCEs. The components of in-hospital MAEs were in-hospital death, myocardial infarction (MI), coronary revascularization, stroke, renal failure, prolonged mechanical ventilation longer than 72 h, and postoperative new cardiac arrhythmia requiring treatment. One-year MACCEs was defined as a composite of all-cause mortality, MI, coronary revascularization, and stroke. There was no significant difference in risk of in-hospital MAEs (OR = 1.29, 95% CI = 0.88–1.88, P = 0.20) or one-year MACCEs (OR = 0.81; 95% CI = 0.46–1.42, P = 0.46) between the groups. The risk of postoperative new arrhythmia including new atrial fibrillation significantly increased in the TIVA group compared to the isoflurane anesthesia group (OR = 1.72, 95% CI = 1.12–2.63, P = 0.01). In conclusion, the choice between propofol-remifentanil TIVA and isoflurane anesthesia did not show differences in incidence of in-hospital MAEs or one-year MACCEs in patients undergoing OPCAB. However, further studies on the effects of anesthetics on development of in-hospital new arrhythmia will be needed.
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Affiliation(s)
- Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gahyun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Kwan Young Hong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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The effect of propofol and sevoflurane on antioxidants and proinflammatory cytokines in a porcine ischemia–reperfusion model. ACTA ACUST UNITED AC 2016; 54:6-10. [DOI: 10.1016/j.aat.2015.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 09/14/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023]
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Ma X, Zhao JY, Zhao ZL, Ye J, Li SF, Fang HH, Gu MN, Hu YW, Qin ZS. Propofol Attenuates Lipopolysaccharide-Induced Monocyte Chemoattractant Protein-1 Production Through Enhancing apoM and foxa2 Expression in HepG2 Cells. Inflammation 2016; 38:1329-36. [PMID: 25586482 DOI: 10.1007/s10753-014-0104-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Monocyte chemoattractant protein-1 (MCP-1) is a cytokine that mediates the influx of cells to sites of inflammation. Our group recently reported that propofol exerted an anti-inflammatory effect and could inhibit lipopolysaccharide (LPS)-induced production of pro-inflammatory cytokines. However, the effect and possible mechanisms of propofol on MCP-1 expression remain unclear. LPS-stimulated HepG2 cells were treated with 50 μM propofol for 0, 6, 12, and 24 h, respectively. The transcript and protein levels were measured by real-time quantitative PCR and Western blot analyses, respectively. We found that propofol markedly decreased both MCP-1 messenger RNA (mRNA) and protein levels in LPS-stimulated HepG2 cells in a time-dependent manner. Expression of apolipoprotein M (apoM) and forkhead box protein A2 (foxa2) was increased by propofol treatment in HepG2 cells. In addition, the inhibitory effect of propofol on MCP-1 expression was significantly abolished by small interfering RNA against apoM and foxa2 in LPS-stimulated HepG2 cells. Propofol attenuates LPS-induced MCP-1 production through enhancing apoM and foxa2 expression in HepG2 cells.
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Affiliation(s)
- Xin Ma
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
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Doi K, Rabb H. Impact of acute kidney injury on distant organ function: recent findings and potential therapeutic targets. Kidney Int 2016; 89:555-64. [PMID: 26880452 DOI: 10.1016/j.kint.2015.11.019] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/03/2015] [Accepted: 11/18/2015] [Indexed: 12/18/2022]
Abstract
Acute kidney injury (AKI) is a common complication in critically ill patients and subsequently worsens outcomes. Although many drugs to prevent and treat AKI have shown benefits in preclinical models, no specific agent has been shown to benefit AKI in humans. Moreover, despite remarkable advances in dialysis techniques that enable management of AKI in hemodynamically unstable patients with shock, dialysis-requiring severe AKI is still associated with an unacceptably high mortality rate. Thus, focusing only on kidney damage and loss of renal function has not been sufficient to improve outcomes of patients with AKI. Recent data from basic and clinical research have begun to elucidate complex organ interactions in AKI between kidney and distant organs, including heart, lung, spleen, brain, liver, and gut. This review serves to update the topic of organ cross talk in AKI and focuses on potential therapeutic targets to improve patient outcomes during AKI-associated multiple organ failure.
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Affiliation(s)
- Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hamid Rabb
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Effects of Sevoflurane and Propofol on Organ Blood Flow in Left Ventricular Assist Devices in Pigs. BIOMED RESEARCH INTERNATIONAL 2015; 2015:898373. [PMID: 26583144 PMCID: PMC4637054 DOI: 10.1155/2015/898373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/16/2015] [Accepted: 06/29/2015] [Indexed: 12/30/2022]
Abstract
The aim of this study was to assess the effect of sevoflurane and propofol on organ blood flow in a porcine model with a left ventricular assist device (LVAD). Ten healthy minipigs were divided into 2 groups (5 per group) according to the anesthetic received (sevoflurane or propofol). A Biomedicus centrifugal pump was implanted. Organ blood flow (measured using colored microspheres), markers of tissue injury, and hemodynamic parameters were assessed at baseline (pump off) and after 30 minutes of partial support. Blood flow was significantly higher in the brain (both frontal lobes), heart (both ventricles), and liver after 30 minutes in the sevoflurane group, although no significant differences were recorded for the lung, kidney, or ileum. Serum levels of alanine aminotransferase and total bilirubin were significantly higher after 30 minutes in the propofol group, although no significant differences were detected between the groups for other parameters of liver function, kidney function, or lactic acid levels. The hemodynamic parameters were similar in both groups. We demonstrated that, compared with propofol, sevoflurane increases blood flow in the brain, liver, and heart after implantation of an LVAD under conditions of partial support.
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Gu MW, Zhang Y, Sun ZY. Effect of total glucosides of paeony on rat hepatic injury after cardiopulmonary bypass. Shijie Huaren Xiaohua Zazhi 2015; 23:3997-4004. [DOI: 10.11569/wcjd.v23.i25.3997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of total glucosides of paeony (TGP) on rat hepatic injury after cardiopulmonary bypass (CPB) and the underlying mechanism.
METHODS: Two hundred rats were randomly divided into a control group, a sham operation group, low-, medium- and high-dose TGP groups. Except the sham operation group, all other groups received CPB. In the low-, medium- and high-dose TGP treatment groups, 0.6, 1.2 and 1.8 mg/kg TGP was added into the priming solution, respectively. After 2 h of CPB, serum levels of transaminases, total bilirubin, prealbumin, transferrin, C-reactive protein, serum amyloid A, tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), IL-6, growth hormone (GH), growth hormone binding protein (GHBP), insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) were detected. Also, the expression of Na+/taurocholate cotransporting polypeptide (NTCP), bile salt export pump (BSEP) and farnesoid X receptor (FXR) in the liver was tested.
RESULTS: Serum levels of glutamic pyruvic transaminase, aspartate transaminase, total bilirubin, prealbumin, transferrin, C-reactive protein, serum amyloid A protein, TNF-α, IL-1β, and IL-6 were significantly higher in the control group after treatment than in the sham operation group (P < 0.05); however, these parameters were significantly lower in the three treatment groups than in the control group (P < 0.05). Serum levels of GH, GHBP, IGF-1 and IGFBP-3 as well as hepatic expression of NTCP, BSEP and FXR were significantly lower in the control group than in the sham operation group (P < 0.05); however, these parameters were significantly higher in the three treatment groups than in the control group (P < 0.05). There were significant differences in all parameters among the three treatment groups (P < 0.05).
CONCLUSION: TGP can protect against liver injury caused by CPB in rats.
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Huddleston LL, Liu KD. Propofol as a panacea for acute kidney injury? Kidney Int 2015; 86:240-3. [PMID: 25079022 DOI: 10.1038/ki.2014.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Yoo and colleagues report a small but provocative randomized clinical trial to prevent acute kidney injury in the setting of cardiopulmonary bypass surgery. Their article describes a trial of 112 patients undergoing valvular surgery with cardiopulmonary bypass who were randomized to receive sevoflurane (an inhaled anesthetic) or propofol for general anesthesia. The use of propofol was associated with a significant decrease in the rate of postoperative acute kidney injury.
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Affiliation(s)
- Lindsey L Huddleston
- Department of Anesthesia, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen D Liu
- 1] Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA [2] Division of Critical Care Medicine, Department of Anesthesia, University of California, San Francisco, San Francisco, California, USA
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Fernandes A, Ettinger J, Amaral F, Ramalho MJ, Alves R, Módolo NSP. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery. Clinics (Sao Paulo) 2014; 69:655-9. [PMID: 25518015 PMCID: PMC4221328 DOI: 10.6061/clinics/2014(10)01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 04/26/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol) or inhalation anesthesia (sevoflurane). In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum) and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/): RBR-8wt2fy RESULTS None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery.
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Affiliation(s)
- Adriano Fernandes
- Department of Anesthesiology, São Rafael Hospital, Salvador, BA, Brazil
| | - João Ettinger
- Department of Surgery, São Rafael Hospital, Salvador, BA, Brazil
| | - Fabiano Amaral
- Department of Anesthesiology, São Rafael Hospital, Salvador, BA, Brazil
| | | | - Rodrigo Alves
- Department of Anesthesiology, São Rafael Hospital, Salvador, BA, Brazil
| | - Norma Sueli Pinheiro Módolo
- Anesthesiology, Department of Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Khajuria A, Tay C, Shi J, Zhao H, Ma D. Anesthetics attenuate ischemia–reperfusion induced renal injury: Effects and mechanisms. ACTA ACUST UNITED AC 2014; 52:176-84. [DOI: 10.1016/j.aat.2014.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 10/01/2014] [Indexed: 12/17/2022]
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Anesthetics influence the incidence of acute kidney injury following valvular heart surgery. Kidney Int 2014; 86:414-22. [DOI: 10.1038/ki.2013.532] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/24/2013] [Accepted: 10/31/2013] [Indexed: 12/31/2022]
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Ding Z, Zhang J, Xu J, Sheng G, Huang G. Propofol administration modulates AQP-4 expression and brain edema after traumatic brain injury. Cell Biochem Biophys 2014; 67:615-22. [PMID: 23494261 DOI: 10.1007/s12013-013-9549-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The increased intracranial pressure caused by brain edema following traumatic brain injury (TBI) always leads to poor patient prognosis. Aquaporin-4 (AQP-4) plays an important role in edema formation and resolution, which may provide a novel therapeutic target for edema treatment. In this present study, we found that propofol treatment, within a short time, after TBI significantly reduced brain edema in a controlled cortical injury rat model and suppressed in vivo expression of AQP-4. The ameliorating effect of propofol was associated with attenuated expression of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). In addition, the regulatory effect of propofol on AQP-4 expression was investigated in cultured astrocytes. Results showed that propofol could block the stimulatory effect of IL-1β and TNF-α on AQP-4 expression in cultured astrocytes. We also found that both NFκB and p38/MAPK pathways were involved in IL-1β and TNF-α-induced AQP-4 expression and that propofol functions as a dual inhibitor of NFκB and p38/MAPK pathways. In conclusion, treatment with propofol, within a short time, after TBI attenuates cerebral edema and reduces the expression of AQP-4. Propofol modulates acute AQP-4 expression by attenuating IL-1β and TNF-α expression and inhibiting IL-1β and TNF-α induced AQP-4 expression.
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Affiliation(s)
- Zhongyang Ding
- Emergency Center, The Affiliated Wuxi People's Hospital, Nanjing Medical University, Wuxi, 214023, China,
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Propofol activation of the Nrf2 pathway is associated with amelioration of acute lung injury in a rat liver transplantation model. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:258567. [PMID: 24669282 PMCID: PMC3941594 DOI: 10.1155/2014/258567] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
Objective. This study aimed to investigate whether propofol pretreatment can protect against liver transplantation-induced acute lung injury (ALI) and to explore whether Nrf2 pathway is involved in the protections provided by propofol pretreatment. Method. Adult male Sprague-Dawley rats were divided into five groups based on the random number table. Lung pathology was observed by optical microscopy. Lung water content was assessed by wet/dry ratio, and PaO2 was detected by blood gas analysis. The contents of H2O2, MDA, and SOD activity were determined by ELISA method, and the expression of HO-1, NQO1, Keap1, and nuclear Nrf2 was assayed by western blotting. Results. Compared with saline-treated model group, both propofol and N-acetylcysteine pretreatment can reduce the acute lung injury caused by orthotopic autologous liver transplantation (OALT), decrease the lung injury scores, lung water content, and H2O2 and MDA levels, and improve the arterial PaO2 and SOD activity. Furthermore, propofol (but not N-acetylcysteine) pretreatment especially in high dose inhibited the expression of Keap1 and induced translocation of Nrf2 into the nucleus to further upregulate the expression of HO-1 and NQO1 downstream. Conclusion. Pretreatment with propofol is associated with attenuation of OALT-induced ALI, and the Nrf2 pathway is involved in the antioxidative processes.
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Marchi N, Granata T, Janigro D. Inflammatory pathways of seizure disorders. Trends Neurosci 2014; 37:55-65. [PMID: 24355813 PMCID: PMC3977596 DOI: 10.1016/j.tins.2013.11.002] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 12/17/2022]
Abstract
Epilepsy refers to a cluster of neurological diseases characterized by seizures. Although many forms of epilepsy have a well-defined immune etiology, in other forms of epilepsy an altered immune response is only suspected. In general, the hypothesis that inflammation contributes to seizures is supported by experimental results. Additionally, antiepileptic maneuvers may act as immunomodulators and anti-inflammatory therapies can treat seizures. Triggers of seizure include a bidirectional communication between the nervous system and organs of immunity. Thus, a crucial cellular interface protecting from immunological seizures is the blood-brain barrier (BBB). Here, we summarize recent advances in the understanding and treatment of epileptic seizures that derive from a non-neurocentric viewpoint and suggest key avenues for future research.
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Affiliation(s)
- Nicola Marchi
- Department of Molecular Medicine, Cerebrovascular Research, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurobiology, Institute of Functional Genomics, Centre National de la Recherche Scientifique, Montpellier, France
| | | | - Damir Janigro
- Department of Molecular Medicine, Cerebrovascular Research, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurological Surgery, Cerebrovascular Research, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA.
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Janigro D, Iffland PH, Marchi N, Granata T. A role for inflammation in status epilepticus is revealed by a review of current therapeutic approaches. Epilepsia 2013; 54 Suppl 6:30-2. [PMID: 24001067 DOI: 10.1111/epi.12271] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A significant number of patients with epilepsy fail to respond to currently available antiepileptic drugs. This suggests a need for alternative approaches to reduce the occurrence of seizures in these patients. Recent data have shown that in addition to well-known neuronal mechanism, seizures may be a consequence of misguided inflammatory response and blood-brain barrier disruption. Both peripheral and brain proinflammatory events have been demonstrated to govern the onset of status epilepticus. Evidence deriving from the experimental and clinical realms supports the notion that a role for proinflammatory and cerebrovascular events in seizure disorders is broader than previously suspected. As a result, methods to pharmacologically reduce blood-brain barrier permeability and reduce inflammation have emerged as means to reduce seizure burden. For instance, corticosteroids have been shown to be beneficial and the same agents may be able to further reduce seizure burden in conjunction with currently prescribed antiepileptic drugs.
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Affiliation(s)
- Damir Janigro
- Departments of Neurological Surgery, Cellular and Molecular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, U.S.A.
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YANG SHUN, CHOU WEIPING, PEI LING. Effects of propofol on renal ischemia/reperfusion injury in rats. Exp Ther Med 2013; 6:1177-1183. [PMID: 24223641 PMCID: PMC3820756 DOI: 10.3892/etm.2013.1305] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022] Open
Abstract
Renal ischemia/reperfusion injury (IRI) is a major cause of acute renal failure. The aim of this study was to investigate whether propofol pretreatment in a rat model protects kidney tissue against IRI. Thirty-two Wistar rats were equally divided into four groups: a sham-operated group, untreated renal IRI group, and low-dose (5 mg/kg) and high-dose (10 mg/kg) propofol-treated groups which were treated with propofol prior to the induction of IRI. The rats were subjected to renal ischemia by bilateral clamping of the pedicles for 50 min, followed by reperfusion. The low-dose and high-dose propofol treatment groups were pretreated via femoral vein injection with a propofol suspension prior to the induction of ischemia/reperfusion. The untreated IRI group showed significantly higher serum creatinine (SCr), blood urea nitrogen (BUN), interleukin 6 (IL-6), IL-8, tumor necrosis factor-α (TNF-α), and malondialdehyde (MDA) levels compared with the sham-operated rats. Superoxide dismutase (SOD) levels were significantly reduced following IRI; however, they significantly increased following propofol administration. Bone morphogenetic protein 2 (BMP2) levels were significantly increased in the propofol-treated groups compared with the untreated IRI group. These results suggest that propofol reduces renal oxidative injury and facilitates repair following IRI. Propofol may play a protective role by regulating BMP2 expression in renal IRI.
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Affiliation(s)
- SHUN YANG
- Department of Anesthesiology, First University Hospital of China Medical University, Shenyang, Liaoning 110000
| | - WEI-PING CHOU
- Department of Anesthesiology, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042,
P.R. China
| | - LING PEI
- Department of Anesthesiology, First University Hospital of China Medical University, Shenyang, Liaoning 110000
- Correspondence to: Dr Ling Pei, Department of Anesthesiology, First University Hospital of China Medical University, 155 S. Nanjing Street, Shenyang, Liaoning 110000, P.R. China, E-mail:
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Budic I, Pavlovic D, Kitic D, Kocic G, Cvetkovic T, Simic D, Jevtovic-Stoimenov T. Tourniquet-induced ischemia-reperfusion injuries during extremity surgery at children's age: impact of anesthetic chemical structure. Redox Rep 2013; 18:20-6. [PMID: 23394494 DOI: 10.1179/1351000212y.0000000037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the relationship between the antioxidant profile of anesthetics and its relation to total antioxidant capacity (TAC) of plasma in children who underwent tourniquet-induced ischemia-reperfusion (IR) injury during extremity operations. METHODS Children were randomized into three groups: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia (TIVA) with propofol (group T), and regional anesthesia (group R). Venous blood samples were obtained before peripheral nerve block and induction of general anesthesia (baseline), 1 minute before tourniquet release (BTR), and 5 and 20 minutes after tourniquet release (ATR). Plasma TAC as well as antioxidant potential of propofol, thiopental, and bupivacaine were measured using the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. RESULTS Plasma TAC in group T was increased significantly at 20 minutes ATR in comparison with basal and BTR values, and also was significantly higher in comparison with plasma TAC in groups S and R measured at the same time point. The radical scavenging activity of anesthetics in vitro indicated that only propofol possessed a significant antioxidative activity in the reaction with DPPH radical in comparison with thiopental and bupivacaine. DISCUSSION These data confirm that TIVA with propofol attenuates oxidative stress related to tourniquet-induced ischaemia-reperfusion injury in children.
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Affiliation(s)
- Ivana Budic
- Centre for Anesthesia, Clinical Centre Nis, Nis, Serbia.
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Yoo YC, Yoo KJ, Lim BJ, Jun JH, Shim JK, Kwak YL. Propofol attenuates renal ischemia-reperfusion injury aggravated by hyperglycemia. J Surg Res 2013; 183:783-91. [DOI: 10.1016/j.jss.2013.02.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
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Cytokine profile in patients undergoing minimally invasive surgery with balanced anesthesia. Inflammation 2013; 35:1807-13. [PMID: 22777067 DOI: 10.1007/s10753-012-9501-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patients undergoing surgical procedure develop an inflammatory response due to surgical trauma that may be modulated by anesthetics. The aim of this study was to investigate the cytokine profile in the plasma of adult patients who underwent minimally invasive surgery with balanced anesthesia with propofol, fentanyl, and sevoflurane. The study included 15 healthy patients scheduled for tympanoplasty or septoplasty under balanced anesthesia. Blood samples were drawn at four time points: before anesthesia, before surgery, 120 min after anesthesia induction, and on the first postoperative day. Plasma interleukin (IL)-1β, -2, -4, -6, -8, -10, -12, TNF-α, and INF-γ levels were assessed by flow cytometry. IL-6 levels were elevated on the day after the surgery (p < 0.001). All other cytokines did not change either during or after balanced anesthesia (p > 0.05). In conclusion, balanced anesthesia with propofol, fentanyl, and sevoflurane anesthesia is not associated with intraoperative changes in the plasma cytokines in healthy patients undergoing minimally invasive otorhinological surgeries. Considering IL-6 results, a postoperative inflammatory response may have occurred due to surgical stress.
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Xiong XQ, Lin LN, Wang LR, Jin LD. Sevoflurane attenuates pulmonary inflammation and ventilator-induced lung injury by upregulation of HO-1 mRNA expression in mice. Int J Nanomedicine 2013; 6:1075-81. [PMID: 23515704 PMCID: PMC3601644 DOI: 10.2147/ijn.s41625] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Mechanical ventilation has been documented to paradoxically cause lung injury. As a commonly used
volatile anesthetic, sevoflurane has been proven to possess antiinflammatory and antioxidative
properties. This study aims to investigate the protective effects of sevoflurane on inflammation and
ventilator-induced lung injury during mechanical ventilation in healthy mice. Methods The adult healthy mice were divided into four groups, each consisting of ten subjects: mice in
group Con-LVT and group Sev-LVT were ventilated with tidal volumes of 8 mL/kg
for 4 hours, while those in group Con-HVT and group Sev-HVT were ventilated
with tidal volumes of 16 mL/kg instead. Control mice (group Con-LVT and
Con-HVT) were subjected to fresh air, while sevoflurane-treated mice (groups Sev-
LVT and Sev-HVT) were subjected to air mixed with 1 vol% sevoflurane.
After 4 hours of ventilation, the bronchoalveolar lavage (BAL) fluid was collected and analyzed for
the levels of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10.
Lung homogenates were harvested to detect the expression of nuclear factor-kappa B (NF-κB)
and heme oxygenase (HO)-1 mRNA by reverse transcription-polymerase chain reaction method. Lung
damage was evaluated using the modified Ventilator-Induced Lung Injury histological scoring
system. Results Compared to group Con-LVT, the levels of TNF-α, IL-1β, IL-6, and IL-10
in BAL fluid, mRNA expressions of NF-κB and HO-1 in lung tissue, and lung injury scores were
significantly increased in group Con-HVT; compared to group Con-HVT, group
Sev-HVT BAL samples showed decreased levels of TNF-α, IL-1β, and IL-6;
they also showed increased levels of IL-10, the downregulation of NF-κB mRNA, and HO-1 mRNA
upregulation; the lung injury scores were significantly lower in group Sev-HVT than group
Con-HVT. Conclusion Mechanical ventilation with high tidal volume might lead to lung injury, which could be
significantly, but not completely, attenuated by sevoflurane inhalation by inhibiting the
NF-κB-mediated proinflammatory cytokine generation and upregulating HO-1 expression.
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Affiliation(s)
- Xiang-qing Xiong
- Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People's Republic of China
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Marchi N, Granata T, Alexopoulos A, Janigro D. The blood-brain barrier hypothesis in drug resistant epilepsy. Brain 2012; 135:e211. [PMID: 22252997 PMCID: PMC3326249 DOI: 10.1093/brain/awr343] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nicola Marchi
- 1 Molecular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- 2 Cell Biology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | | | | - Damir Janigro
- 1 Molecular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- 2 Cell Biology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- 5 Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
- 6 Cerebrovascular Research, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Addition of a Water-Soluble Propofol Formulation to Preservation Solution in Experimental Kidney Transplantation. Transplantation 2011; 92:296-302. [DOI: 10.1097/tp.0b013e3182247b78] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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