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Skakum M, Katako A, Mitchell-Dueck J, Ricci MF, Russell K. Risk of attention deficit hyperactivity disorder diagnosis following multiple exposures to general anesthesia in the paediatric population: A systematic review and meta-analysis. Paediatr Child Health 2024; 29:29-35. [PMID: 38332968 PMCID: PMC10848114 DOI: 10.1093/pch/pxad074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/13/2023] [Indexed: 02/10/2024] Open
Abstract
Objectives The risk of attention deficit hyperactivity disorder (ADHD) following multiple exposures to anesthesia has been debated. Our objective was to systematically review the literature to examine the association between multiple exposures to general anesthesia before age 5 and subsequent diagnosis of ADHD. Methods A systematic search of EMBASE, PubMed, and SCOPUS was performed using key search terms in February 2022. We included studies that: were published after 1980, included only otherwise healthy children who experienced two or more exposures to general anesthetic before age 5, diagnosed ADHD by a medical professional before age 19 years after exposure to general anesthetic, were cross-sectional, case-control, or cohort study, and were published in English. The results (expressed as hazard ratios [HR] and associated 95% confidence intervals [CI]) were pooled using meta-analytic techniques. Studies which did not present their results as HR and 95% CI were analyzed separately. GRADE was used to determine the certainty of the findings. PRISMA guidelines were followed at each stage of the review. Results Eight studies (196,749 children) were included. Five reported HR and 95% CI and were subsequently pooled for meta-analysis. Multiple exposures to anesthesia were associated with diagnosis of ADHD before the 19th year of life (HR: 1.71; 95% CI: 1.59, 1.84). Two of the three studies not used in the meta-analysis also found an increased risk of ADHD diagnosis following multiple anesthetic exposures. Conclusions There was an association between multiple early exposures to general anesthesia and later diagnosis of ADHD.
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Affiliation(s)
- Megan Skakum
- University of Manitoba Master of Physician Assistant Studies Program, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Audrey Katako
- University of Manitoba Master of Physician Assistant Studies Program, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - M Florencia Ricci
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Specialized Services for Children and Youth (SSCY) Centre, Winnipeg, Manitoba, Canada
| | - Kelly Russell
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Associations between maternal exposure to surgery or pregnancy exposure to fluorinated anesthetics and children's cognitive development and educational outcomes. J Dev Orig Health Dis 2023; 14:199-208. [PMID: 35968856 DOI: 10.1017/s2040174422000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A transgenerational, epigenetic effect of anesthesia, particularly fluorinated agents, has been examined in rat models, but translation to humans is unclear. This study examined associations of maternal lifetime exposure to anesthesia and pregnancy exposure to fluorinated anesthetics with child cognitive and educational outcomes. Women in the US Collaborative Perinatal Project (1959-1963) reported lifetime history of surgeries, and the obstetric record captured pregnancy exposure to anesthetics. Children were followed to age 7 for global cognitive ability and educational outcomes (n=47,977). Logistic and linear regressions were adjusted for maternal and child birth years, race and ethnicity, smoking, education, parity, study site. Many outcomes were not associated with exposure to maternal surgery that occurred at various life stages. However, maternal surgery in early childhood was associated both with being in a special school or not in school (adj OR=1.42; 95% CI 1.02, 1.98) and with slightly better cognitive ability across childhood (e.g., WISC IQ (adj β=0.59; CI 0.13, 1.04) (especially among boys)). Maternal surgery in puberty was associated with slightly lower IQ (adj β = -0.42; CI -0.79, -0.05) and poorer spelling at age 7. Children's prenatal exposure to fluorinated anesthetics was associated with slightly better spelling ability (adj β = 1.20; CI 0.02, 2.38) but lower performance IQ at age 7 (only among boys, adj β = -1.97; CI -3.88, -0.06). This study shows inconsistent evidence of effects of maternal exposure to surgery or prenatal exposure to fluorinated agents on child developmental and educational outcomes Residual confounding by indication and socioeconomic status may explain observed associations.
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Tan R, Wang F, Zhou Y, Huang Z, An Z, Xu Y. Neural functions in cancer: Data analyses and database construction. Front Genet 2023; 14:1062052. [PMID: 36861131 PMCID: PMC9968960 DOI: 10.3389/fgene.2023.1062052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
Recent studies have revealed that neural functions are involved in possibly every aspect of a cancer development, serving as bridges connecting microenvironmental stressors, activities of intracellular subsystems, and cell survival. Elucidation of the functional roles played by the neural system could provide the missing links in developing a systems-level understanding of cancer biology. However, the existing information is highly fragmented and scattered across the literature and internet databases, making it difficult for cancer researchers to use. We have conducted computational analyses of transcriptomic data of cancer tissues in TCGA and tissues of healthy organs in GTEx, aiming to demonstrate how the functional roles by the neural genes could be derived and what non-neural functions they are associated with, across different stages of 26 cancer types. Several novel discoveries are made, including i) the expressions of certain neural genes can predict the prognosis of a cancer patient; ii) cancer metastasis tends to involve specific neural functions; iii) cancers of low survival rates involve more neural interactions than those with high survival rates; iv) more malignant cancers involve more complex neural functions; and v) neural functions are probably induced to alleviate stresses and help the associated cancer cells to survive. A database, called NGC, is developed for organizing such derived neural functions and associations, along with gene expressions and functional annotations collected from public databases, aiming to provide an integrated and publicly available information resource to enable cancer researchers to take full advantage of the relevant information in their research, facilitated by tools provided by NGC.
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Affiliation(s)
- Renbo Tan
- Key Laboratory of Symbolic Computation and knowledge Engineering, College of Computer Science and Technology, Jilin University, Changchun, China,Cancer Systems Biology Center, China-Japan Union Hospital of Jilin University, Changchun, China,*Correspondence: Renbo Tan, ; Ying Xu,
| | - Feilong Wang
- Key Laboratory of Symbolic Computation and knowledge Engineering, College of Computer Science and Technology, Jilin University, Changchun, China,Cancer Systems Biology Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yi Zhou
- Computational Systems Biology Lab, Department of Biochemistry and Molecular Biology, And Institute of Bioinformatics, University of Georgia, Athens, GA, United States
| | - Zhenyu Huang
- Key Laboratory of Symbolic Computation and knowledge Engineering, College of Computer Science and Technology, Jilin University, Changchun, China,Cancer Systems Biology Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zheng An
- Computational Systems Biology Lab, Department of Biochemistry and Molecular Biology, And Institute of Bioinformatics, University of Georgia, Athens, GA, United States
| | - Ying Xu
- Cancer Systems Biology Center, China-Japan Union Hospital of Jilin University, Changchun, China,Computational Systems Biology Lab, Department of Biochemistry and Molecular Biology, And Institute of Bioinformatics, University of Georgia, Athens, GA, United States,*Correspondence: Renbo Tan, ; Ying Xu,
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Fedorov A, Lehto A, Klein J. Inhibition of mitochondrial respiration by general anesthetic drugs. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:375-381. [PMID: 36385685 PMCID: PMC9832080 DOI: 10.1007/s00210-022-02338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
General anesthetic drugs have been associated with various unwanted effects including an interference with mitochondrial function. We had previously observed increases of lactate formation in the mouse brain during anesthesia with volatile anesthetic agents. In the present work, we used mitochondria that were freshly isolated from mouse brain to test mitochondrial respiration and ATP synthesis in the presence of six common anesthetic drugs. The volatile anesthetics isoflurane, halothane, and (to a lesser extent) sevoflurane caused an inhibition of complex I of the electron transport chain in a dose-dependent manner. Significant effects were seen at concentrations that are reached under clinical conditions (< 0.5 mM). Pentobarbital and propofol also inhibited complex I but at concentrations that were two-fold higher than clinical EC50 values. Only propofol caused an inhibition of complex II. Complex IV respiration was not affected by either agent. Ketamine did not affect mitochondrial respiration. Similarly, all anesthetic agents except ketamine suppressed ATP production at high concentrations. Only halothane increased cytochrome c release indicating damage of the mitochondrial membrane. In summary, volatile general anesthetic agents as well as pentobarbital and propofol dose-dependently inhibit mitochondrial respiration. This action may contribute to depressive actions of the drugs in the brain.
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Affiliation(s)
- Anton Fedorov
- Department of Pharmacology and Clinical Pharmacy, College of Pharmacy, Goethe University Frankfurt, Max-Von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Alina Lehto
- Department of Pharmacology and Clinical Pharmacy, College of Pharmacy, Goethe University Frankfurt, Max-Von-Laue-Str. 9, 60438 Frankfurt, Germany
| | - Jochen Klein
- Department of Pharmacology and Clinical Pharmacy, College of Pharmacy, Goethe University Frankfurt, Max-Von-Laue-Str. 9, 60438 Frankfurt, Germany
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Wan Y, Wu Z, Li X, Zhao P. Maternal sevoflurane exposure induces neurotoxicity in offspring rats via the CB1R/CDK5/p-tau pathway. Front Pharmacol 2023; 13:1066713. [PMID: 36703741 PMCID: PMC9871255 DOI: 10.3389/fphar.2022.1066713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Abstract
Sevoflurane is widely used for maternal anesthesia during pregnancy. Sevoflurane exposure of rats at mid-gestation can cause abnormal development of the central nervous system in their offspring. Sevoflurane is known to increase the expression of cannabinoid 1 receptor (CB1R) in the hippocampus. However, the effect of cannabinoid 1 receptor on fetal and offspring rats after maternal anesthesia is still unclear. At gestational day 14, pregnant rats were subjected to 2-h exposure to 3.5% sevoflurane or air. Rats underwent intraperitoneal injection with saline or rimonabant (1 mg/kg) 30 min prior to sevoflurane or air exposure. cannabinoid 1 receptor, cyclin-dependent kinase 5 (CDK5), p35, p25, tau, and p-tau expression in fetal brains was measured at 6, 12, and 24 h post-sevoflurane/air exposure. Neurobehavioral and Morris water maze tests were performed postnatal days 3-33. The expression of cannabinoid 1 receptor/cyclin-dependent kinase 5/p-tau and histopathological staining of brain tissues in offspring rats was observed. We found that a single exposure to sevoflurane upregulated the activity of cyclin-dependent kinase 5 and the level of p-tau via cannabinoid 1 receptor. This was accompanied by the diminished number of neurons and dendritic spines in hippocampal CA1 regions. Finally, these effects induced lower scores and platform crossing times in behavioral tests. The present study suggests that a single exposure to 3.5% sevoflurane of rats at mid-gestation impairs neurobehavioral abilities and cognitive memory in offspring. cannabinoid 1 receptor is a possible target for the amelioration of postnatal neurobehavioral ability and cognitive memory impairments induced by maternal anesthesia.
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Ikonomidou C, Wang SH, Fuhler NA, Larson S, Capuano S, Brunner KR, Crosno K, Simmons HA, Mejia AF, Noguchi KK. Mild hypothermia fails to protect infant macaques from brain injury caused by prolonged exposure to Antiseizure drugs. Neurobiol Dis 2022; 171:105814. [PMID: 35817217 PMCID: PMC9354232 DOI: 10.1016/j.nbd.2022.105814] [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: 04/01/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 01/28/2023] Open
Abstract
Barbiturates and benzodiazepines are GABAA-receptor agonists and potent antiseizure medications. We reported that exposure of neonatal macaques to combination of phenobarbital and midazolam (Pb/M) for 24 h, at clinically relevant doses and plasma levels, causes widespread apoptosis affecting neurons and oligodendrocytes. Notably, the extent of injury was markedly more severe compared to shorter (8 h) exposure to these drugs. We also reported that, in the infant macaque, mild hypothermia ameliorates the apoptosis response to the anesthetic sevoflurane. These findings prompted us explore whether mild hypothermia might protect infant nonhuman primates from neuro- and gliotoxicity of Pb/M. Since human infants with seizures may receive combinations of benzodiazepines and barbiturates for days, we opted for 24 h treatment with Pb/M. Neonatal rhesus monkeys received phenobarbital intravenously, followed by midazolam infusion over 24 h under normothermia (T > 36.5 °C-37.5 °C; n = 4) or mild hypothermia (T = 35 °C-36.5 °C; n = 5). Medication doses and blood levels measured were comparable to those in human infants. Animals were euthanized at 36 h and brains examined immunohistochemically and stereologically. Treatment was well tolerated. Extensive degeneration of neurons and oligodendrocytes was seen at 36 h in both groups within neocortex, basal ganglia, hippocampus and brainstem. Mild hypothermia over 36 h (maintained until terminal perfusion) conferred no protection against the neurotoxic and gliotoxic effects of Pb/M. This is in marked contrast to our previous findings that mild hypothermia is protective in the context of a 5 h-long exposure to sevoflurane in infant macaques. These findings demonstrate that brain injury caused by prolonged exposure to Pb/M in the neonatal primate cannot be ameliorated by mild hypothermia.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin, School of Medicine, Madison, WI, USA.
| | - Sophie H Wang
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Nicole A Fuhler
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Shreya Larson
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin R Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin K Noguchi
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
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Doi H, Matsuda T, Sakai A, Matsubara S, Hoka S, Yamaura K, Nakashima K. Early-life midazolam exposure persistently changes chromatin accessibility to impair adult hippocampal neurogenesis and cognition. Proc Natl Acad Sci U S A 2021; 118:e2107596118. [PMID: 34526402 PMCID: PMC8463898 DOI: 10.1073/pnas.2107596118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Linkage between early-life exposure to anesthesia and subsequent learning disabilities is of great concern to children and their families. Here we show that early-life exposure to midazolam (MDZ), a widely used drug in pediatric anesthesia, persistently alters chromatin accessibility and the expression of quiescence-associated genes in neural stem cells (NSCs) in the mouse hippocampus. The alterations led to a sustained restriction of NSC proliferation toward adulthood, resulting in a reduction of neurogenesis that was associated with the impairment of hippocampal-dependent memory functions. Moreover, we found that voluntary exercise restored hippocampal neurogenesis, normalized the MDZ-perturbed transcriptome, and ameliorated cognitive ability in MDZ-exposed mice. Our findings thus explain how pediatric anesthesia provokes long-term adverse effects on brain function and provide a possible therapeutic strategy for countering them.
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Affiliation(s)
- Hiroyoshi Doi
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
| | - Taito Matsuda
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan;
| | - Atsuhiko Sakai
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
| | - Shuzo Matsubara
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
| | - Sumio Hoka
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
- Department of Pharmaceutical Sciences, International University of Health and Welfare, 831-8501 Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan
| | - Kinichi Nakashima
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, 812-8582 Fukuoka, Japan;
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Ponde VC, Chavan DN, Desai AP, Gursale AA, Bedekar VV, Puranik KA. Avoidance of deep anesthesia and artificial airways in 1000 neonates and infants using regional anesthesia: A retrospective observational analysis. J Anaesthesiol Clin Pharmacol 2021; 36:386-390. [PMID: 33487908 PMCID: PMC7812947 DOI: 10.4103/joacp.joacp_200_17] [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: 07/26/2017] [Revised: 05/16/2018] [Accepted: 10/06/2019] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Current concerns related to the anesthetic neurotoxicity have brought a renewed interest in regional anesthesia. Regional anesthesia reduces the need for opioids and inhalational anesthetics. The immaturity of the neonatal and infant nervous system may render them more prone to neurotoxicity. We describe our technique of anesthesia, which minimizes the exposure to general anesthetics and reduces airway instrumentation because the operability is rendered by the regional block. Material and Methods This was a retrospective case series of neonates and infants undergoing common surface surgeries. We describe our technique of anesthesia where regional blocks are the mainstay. We also put up the data pertaining to block effectiveness, technique, end-tidal sevoflurane concentration and complications. Results One thousand patients, including neonates and infants, received central and peripheral nerve blockade. The failure rate in upper extremity blocks 0% without complications. 86.12% were given under ultrasonography (USG) guidance and 13.89% were given with peripheral nerve stimulation. The failure rate of sciatic block single shot and continuous was 0%. 92.53% were given with USG guidance while 7.46% received sciatic with nerve stimulation technique. Failure rate of caudal epidural block was 0. 78% requiring a rescue analgesic, 1.4% had blood in the needle. Out of the caudals, 33.33% were done with USG guidance and 66.67% blocks were given with traditional techniques. Out of the 322 penile + ring blocks given by traditional method, 1 block failed requiring rescue analgesics. The mean sevoflurane concentration was 1.2 +/- 0.32. Conclusion It is feasible to conduct surface surgeries in the most vulnerable population such as neonates and infants under regional anesthesia without intubation and airway instrumentation.
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Affiliation(s)
- Vrushali C Ponde
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
| | - Dilip N Chavan
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
| | - Ankit P Desai
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
| | - Anuya A Gursale
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
| | - Vinit V Bedekar
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
| | - Kiran A Puranik
- Children Anaesthesia Services, Department of Anaesthesia, Mumbai, Maharashtra, India
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Abstract
Background: Although nitrous oxide (N2O) has been used since the 1880s for labor analgesia, its popularity has only recently increased in the United States. In 2011, only 3 centers in the country offered N2O, but as of 2020, several hundred labor units have adopted its use. Methods: We reviewed the literature and summarize the mechanism of action, clinical uses, and efficacy of N2O for labor analgesia, as well as patient satisfaction related to its use. Results: N2O has several proposed mechanisms of action that make it a viable option for all 3 stages of labor and postpartum procedures. N2O has been shown to be a safe option for both mom and baby during labor and delivery. Studies support N2O as an analgesic for laboring. Even though 40% to 60% of women who use N2O convert to a labor epidural analgesia, satisfaction surveys indicate that analgesia is not the only factor contributing to the use of N2O during labor. Conclusion: The use of N2O has increased in labor and delivery units across the United States since 2011. Despite inferior analgesic properties compared to epidural analgesia, N2O offers a safe alternative for many parturients who want a greater sense of control and mobility.
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Abstract
OBJECTIVE. Pediatric CT angiography (CTA) presents unique challenges compared with adult CTA. Because of the ionizing radiation exposure, CTA should be used judiciously in children. The pearls offered here are observations gleaned from the authors' experience in the use of pediatric CTA. We also present some potential follies to be avoided. CONCLUSION. Understanding the underlying principles and paying meticulous attention to detail can substantially optimize dose and improve the diagnostic quality of pediatric CTA.
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Maloney SE, Creeley CE, Hartman RE, Yuede CM, Zorumski CF, Jevtovic-Todorovic V, Dikranian K, Noguchi KK, Farber NB, Wozniak DF. Using animal models to evaluate the functional consequences of anesthesia during early neurodevelopment. Neurobiol Learn Mem 2019; 165:106834. [PMID: 29550366 PMCID: PMC6179938 DOI: 10.1016/j.nlm.2018.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
Fifteen years ago Olney and colleagues began using animal models to evaluate the effects of anesthetic and sedative agents (ASAs) on neurodevelopment. The results from ongoing studies indicate that, under certain conditions, exposure to these drugs during development induces an acute elevated apoptotic neurodegenerative response in the brain and long-term functional impairments. These animal models have played a significant role in bringing attention to the possible adverse effects of exposing the developing brain to ASAs when few concerns had been raised previously in the medical community. The apoptotic degenerative response resulting from neonatal exposure to ASAs has been replicated in many studies in both rodents and non-human primates, suggesting that a similar effect may occur in humans. In both rodents and non-human primates, significantly increased levels of apoptotic degeneration are often associated with functional impairments later in life. However, behavioral deficits following developmental ASA exposure have not been consistently reported even when significantly elevated levels of apoptotic degeneration have been documented in animal models. In the present work, we review this literature and propose a rodent model for assessing potential functional deficits following neonatal ASA exposure with special reference to experimental design and procedural issues. Our intent is to improve test sensitivity and replicability for detecting subtle behavioral effects, and thus enhance the translational significance of ASA models.
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Affiliation(s)
- Susan E Maloney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - Catherine E Creeley
- Department of Psychology, The State University of New York at Fredonia, Fredonia, NY 14063, USA
| | - Richard E Hartman
- Department of Psychology, Loma Linda University, 11130 Anderson St., Loma Linda, CA 92354, USA
| | - Carla M Yuede
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles F Zorumski
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Krikor Dikranian
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, USA
| | - Kevin K Noguchi
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA
| | - David F Wozniak
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA; Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine, St. Louis, MO, USA; Intellectual and Developmental Disabilities Research Center, Washington University, St. Louis, MO, USA.
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Ikonomidou C, Kirvassilis G, Swiney BS, Wang SH, Huffman JN, Williams SL, Masuoka K, Capuano S, Brunner KR, Crosno K, Simmons HS, Mejia AF, Turski CA, Brambrink A, Noguchi KK. Mild hypothermia ameliorates anesthesia toxicity in the neonatal macaque brain. Neurobiol Dis 2019; 130:104489. [PMID: 31175984 PMCID: PMC6689440 DOI: 10.1016/j.nbd.2019.104489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 01/18/2023] Open
Abstract
Sedatives and anesthetics can injure the developing brain. They cause apoptosis of neurons and oligodendrocytes, impair synaptic plasticity, inhibit neurogenesis and trigger long-term neurocognitive deficits. The projected vulnerable period in humans extends from the third trimester of pregnancy to the third year of life. Despite all concerns, there is no ethically and medically acceptable alternative to the use of sedatives and anesthetics for surgeries and painful interventions. Development of measures that prevent injury while allowing the medications to exert their desired actions has enormous translational value. Here we investigated protective potential of hypothermia against histological toxicity of the anesthetic sevoflurane in the developing nonhuman primate brain. Neonatal rhesus monkeys underwent sevoflurane anesthesia over 5 h. Body temperature was regulated in the normothermic (>36.5 °C), mild hypothermic (35-36.5 °C) and moderately hypothermic (<35 °C) range. Animals were euthanized at 8 h and brains examined immunohistochemically (activated caspase 3) and stereologically to quantify apoptotic neuronal and oligodendroglial death. Sevoflurane anesthesia was well tolerated at all temperatures, with oxygen saturations, end tidal CO2 and blood gases remaining at optimal levels. Compared to controls, sevoflurane exposed brains displayed significant apoptosis in gray and white matter affecting neurons and oligodendrocytes. Mild hypothermia (35-36.5 °C) conferred significant protection from apoptotic brain injury, whereas moderate hypothermia (<35 °C) did not. Hypothermia ameliorates anesthesia-induced apoptosis in the neonatal primate brain within a narrow temperature window (35-36.5 °C). Protection is lost at temperatures below 35 °C. Given the mild degree of cooling needed to achieve significant brain protection, application of our findings to humans should be explored further.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA.
| | - George Kirvassilis
- Department of Anesthesiology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Brant S Swiney
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sophie H Wang
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Jacob N Huffman
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sasha L Williams
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Kobe Masuoka
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin R Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Christopher A Turski
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Ansgar Brambrink
- Department of Anesthesiology, Columbia University, New York Presbyterian Hospital, Irving Medical Center, New York, NY, USA
| | - Kevin K Noguchi
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
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Hu X, Hu X, Huang G. LncRNA MALAT1 is involved in sevoflurane-induced neurotoxicity in developing rats. J Cell Biochem 2019; 120:18209-18218. [PMID: 31190336 DOI: 10.1002/jcb.29127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study is to uncover the effects of long chain noncoding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) on sevoflurane-induced neurotoxicity in developing rats. METHODS Sevoflurane neurotoxicity model was established by sevoflurane treatment in 7-day-old Sprague-Dawley rats. The rats were treated with Sevo or MALAT1 small interfering RNA to detect the MALAT1 expression, pathological change, ultrastructure, neuronal apoptosis, expression of apoptosis-related proteins, expression of neurotrophic factors BDNF and NGF, spatial learning and memory function change, as well as neuron cell density of hippocampal tissues. RESULTS MALAT1 was highly expressed in hippocampus tissues of rats. Downregulation of MALAT1 alleviated the pathological change, improved the ultrastructure, inhibited apoptosis of neuronal cells, declined caspase 3 and Bax while elevated Bcl-2, BDNF and NGF, improved capability of spatial learning and memory, and increased density of hippocampal neurons in hippocampal tissues of sevoflurane-induced rats. CONCLUSION Suppression of MALAT1 can reduce the apoptosis of hippocampal neurons induced by sevoflurane anesthesia, improve the capability of spatial learning, and memory function and alleviate the loss of hippocampal nerve cells in developing rats. To a certain extent, it plays the role of protecting brain nerve cells.
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Affiliation(s)
- Xueyan Hu
- Department of Anesthesiology, Yishui Central Hospital, Linyi, People's Republic of China
| | - Xiaodong Hu
- Department of Anesthesiology, Yishui Central Hospital, Linyi, People's Republic of China
| | - Guirong Huang
- Department of Anesthesiology, Yishui Central Hospital, Linyi, People's Republic of China
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Abstract
The solute carrier (SLC) group of membrane transport proteins includes about 400 members organized into more than 50 families. The SLC family that comprises nucleoside-sugar transporters is referred to as SLC35. One of the members of this family is SLC35F1. The function of SLC35F1 is still unknown; however, recent studies demonstrated that SLC35F1 mRNA is highly expressed in the brain and in the kidney. Therefore, we examine the distribution of Slc35f1 protein in the murine forebrain using immunohistochemistry. We could demonstrate that Slc35f1 is highly expressed in the adult mouse brain in a variety of different brain structures, including the cortex, hippocampus, amygdala, thalamus, basal ganglia, and hypothalamus. To examine the possible roles of Slc35f1 and its subcellular localization, we used an in vitro glioblastoma cell line expressing Slc35f1. Co-labeling experiments were performed to reveal the subcellular localization of Slc35f1. Our results indicate that Slc35f1 neither co-localizes with markers for the Golgi apparatus nor with markers for the endoplasmic reticulum. Time-lapse microscopy of living cells revealed that Slc35f1-positive structures are highly dynamic and resemble vesicles. Using super-resolution microscopy, these Slc35f1-positive spots clearly co-localize with the recycling endosome marker Rab11.
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Noguchi KK, Johnson SA, Dissen GA, Martin LD, Manzella FM, Schenning KJ, Olney JW, Brambrink AM. Isoflurane exposure for three hours triggers apoptotic cell death in neonatal macaque brain. Br J Anaesth 2019; 119:524-531. [PMID: 28969320 DOI: 10.1093/bja/aex123] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 01/21/2023] Open
Abstract
Background Retrospective clinical studies suggest there is a risk for neurodevelopmental impairment following early childhood exposure to anaesthesia. In the developing animal brain, including those of non-human primates (NHPs), anaesthetics induce apoptotic cell death. We previously reported that a 5 h isoflurane (ISO) exposure in infant NHPs increases apoptosis 13-fold compared with control animals. However, the majority of paediatric surgeries requiring anaesthesia are of shorter durations. We examined whether 3 h ISO exposure similarly increases neuroapoptosis in the NHP developing brain. Methods Six-day-old NHP infants ( Macaca mulatta ) were exposed to 3 h of a surgical plane of ISO ( n =6) or to room air ( n =5). Following exposure, NHP brains were screened for neuronal and oligodendrocyte apoptosis using activated caspase-3 immunolabelling and unbiased stereology. Results ISO treatment increased apoptosis (neurones + oligodendrocyte) to greater than four times that in the control group [mean density of apoptotic profiles: 57 (SD 22) mm -3 vs 14 (SD 5.2) mm -3 , respectively]. Oligodendrocyte apoptosis was evenly distributed throughout the white matter whereas neuroapoptosis occurred primarily in the cortex (all regions), caudate, putamen and thalamus. Conclusions A 3 h exposure to ISO is sufficient to induce widespread neurotoxicity in the developing primate brain. These results are relevant for clinical medicine, as many surgical and diagnostic procedures in children require anaesthesia durations similar to those modelled here. Further research is necessary to identify long-term neurobehavioural consequences of 3 h ISO exposure.
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Affiliation(s)
- K K Noguchi
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - S A Johnson
- Department of Internal Medicine, University of Missouri, Columbia, Columbia, MO 65212, USA
| | - G A Dissen
- Division of Neuroscience, Oregon Health & Science University, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
| | - L D Martin
- Division of Comparative Medicine, Oregon Health & Science University, Oregon National Primate Research Center, 505 NW 185th Ave, Beaverton, OR 97006, USA
| | - F M Manzella
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - K J Schenning
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA
| | - J W Olney
- Department of Psychiatry, Washington University in St Louis, 660?S. Euclid Ave, St Louis, MO 63108, USA
| | - A M Brambrink
- Department of Anesthesia, Columbia University/NewYork-Presbyterian Hospital, 622 West 168th Street, New York, NY, 10032, USA
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16
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Eustaquio T, Wang C, Dugard CK, George NI, Liu F, Slikker W, Paule MG, Howard PC, Paredes AM. Electron microscopy techniques employed to explore mitochondrial defects in the developing rat brain following ketamine treatment. Exp Cell Res 2018; 373:164-170. [PMID: 30342004 DOI: 10.1016/j.yexcr.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
Ketamine, an FDA-approved N-methyl-D-aspartate (NMDA) receptor antagonist, is commonly used for general pediatric anesthesia. Accumulating evidence has indicated that prolonged exposure to ketamine induces widespread apoptotic cell death in the developing brains of experimental animals. Although mitochondria are known to play a pivotal role in cell death, little is known about the alterations in mitochondrial ultrastructure that occur during ketamine-induced neurotoxicity. The objective of this pilot study was to utilize classic and contemporary methods in electron microscopy to study the impact of ketamine on the structure of mitochondria in the developing rat brain. While transmission electron microscopy (TEM) was employed to comprehensively study mitochondrial inner membrane topology, serial block-face scanning electron microscopy (SBF-SEM) was used as a complementary technique to compare the overall mitochondrial morphology from a representative treated and untreated neuron. In this study, postnatal day 7 (PND-7) Sprague-Dawley rats were treated with ketamine or saline (6 subcutaneous injections × 20 mg/kg or 10 ml/kg, respectively, at 2-h intervals with a 6-h withdrawal period after the last injection, n=6 each group). Samples from the frontal cortex were harvested and analyzed using TEM or SBF-SEM. While classic TEM revealed that repeated ketamine exposure induces significant mitochondrial swelling in neurons, the newer technique of SBF-SEM confirmed the mitochondrial swelling in three dimensions (3D) and showed that ketamine exposure may also induce mitochondrial fission, which was not observable in the two dimensions (2D) of TEM. Furthermore, 3D statistical analysis of these reconstructed mitochondria appeared to show that ketamine-treated mitochondria had significantly larger volumes per unit surface area than mitochondria from the untreated neuron. The ultrastructural mitochondrial alterations demonstrated here by TEM and SBF-SEM support ketamine's proposed mechanism of neurotoxicity in the developing rat brain.
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Affiliation(s)
- Trisha Eustaquio
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Cheng Wang
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Christopher K Dugard
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Nysia I George
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Fang Liu
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - William Slikker
- Office of the Center Director, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Merle G Paule
- Division of Neurotoxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Paul C Howard
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States
| | - Angel M Paredes
- NCTR/ORA Nanotechnology Core Facility, Office of Scientific Coordination, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR 72079, United States.
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Mutch WAC, El-Gabalawy RM, Graham MR. Postoperative Delirium, Learning, and Anesthetic Neurotoxicity: Some Perspectives and Directions. Front Neurol 2018; 9:177. [PMID: 29615969 PMCID: PMC5869196 DOI: 10.3389/fneur.2018.00177] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/07/2018] [Indexed: 01/04/2023] Open
Abstract
Evidence of anesthetic neurotoxicity is unequivocal when studied in animal models. These findings have translated poorly to the clinical domain when equated to postoperative delirium (POD) in adults and postoperative cognitive dysfunction (POCD) in either children or the elderly. In this perspective, we examine various reasons for the differences between animal modeling of neurotoxicity and the clinical situation of POD and POCD and make suggestions as to potential directions for ongoing research. We hypothesize that the animal anesthetic neurotoxicity models are limited, in part, due to failed scaling correction of physiological time. We posit that important insights into POCD in children and adults may be gleaned from studies in adults examining alterations in perioperative management designed to limit POD. In this way, POD may be more useful as the proxy for POCD rather than neuronal dropout or behavioral abnormalities that have been used in animal models but which may not be proxies for the human condition. We argue that it is time to move beyond animal models of neurotoxicity to directly examine these problems in well-conducted clinical trials with comprehensive preoperative neuropsychometric and psychiatric testing, high fidelity intraoperative monitoring of physiological parameters during the anesthetic course and postoperative assessment of subthreshold and full classification of POD. In this manner, we can “model ourselves” to better understand these important and poorly understood conditions.
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Affiliation(s)
- W Alan C Mutch
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Renée M El-Gabalawy
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada.,Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - M Ruth Graham
- Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada
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18
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Variability in Imaging Practices and Comparative Cumulative Effective Dose for Neuroblastoma and Nephroblastoma Patients at 6 Pediatric Oncology Centers. J Pediatr Hematol Oncol 2018; 40:36-42. [PMID: 28697171 DOI: 10.1097/mph.0000000000000915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to estimate the cumulative effective dose (CED) from diagnosis and posttherapy computed tomographic (CT) scans performed on children treated for neuroblastoma or nephroblastoma (Wilms tumor) and to examine the different imaging practices used in 6 regional pediatric oncology centers between January 2010 and December 2013. We analyzed retrospectively the CT scan acquisition data in children aged 10 years or younger at diagnosis. The use of nonionizing imaging modalities was reported. The CT examinations of 129 children, with a mean age at diagnosis of 36 months, treated for 66 neuroblastomas and 63 nephroblastomas, were analyzed. The mean follow-up period was 28 months (minimum, 8 months, maximum, 41 mo). There were 600 CT scans, with a total of 1039 acquisitions. The mean CED from CT scans was 27 mSv (minimum=18.25, maximum=45). Abdominal CT examinations contributed 85% of the total CED. A median of 4.6 CT scans, 10.3 sonograms, and 0.4 magnetic resonance imaging examinations per child were performed. Our results suggest a reduction in radiation exposure but variability in the imaging modality choice and acquisition protocols. We emphasize the need for consensus and standardization in oncologic pediatric imaging procedures. When feasible, we encourage the substitution of nonionizing examinations for CT.
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19
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Longo M, Genovese E, Orlandi C, Donatiello S, Cassano B, Colajacomo M, Magistrelli A, Tomà P, Cannatà V. A novel method for CT dosimetry with a suspended phantom setup. Phys Med 2017; 40:122-129. [DOI: 10.1016/j.ejmp.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 11/24/2022] Open
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Wang Q, Shen FY, Zou R, Zheng JJ, Yu X, Wang YW. Ketamine-induced apoptosis in the mouse cerebral cortex follows similar characteristic of physiological apoptosis and can be regulated by neuronal activity. Mol Brain 2017. [PMID: 28623920 PMCID: PMC5474024 DOI: 10.1186/s13041-017-0302-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The effects of general anesthetics on inducing neuronal apoptosis during early brain development are well-documented. However, since physiological apoptosis also occurs during this developmental window, it is important to determine whether anesthesia-induced apoptosis targets the same cell population as physiological apoptosis or different cell types altogether. To provide an adequate plane of surgery, ketamine was co-administered with dexmedetomidine. The apoptotic neurons in the mouse primary somatosensory cortex (S1) were quantitated by immunohistochemistry. To explore the effect of neural activity on ketamine-induced apoptosis, the approaches of Designer Receptors Exclusively Activated by Designer Drugs (DREADDs) and an environmental enrichment (EE) were performed. Ketamine-induced apoptosis in S1 is most prominent at postnatal days 5 and 7 (P5 – P7), and becomes insignificant by P12. Physiological and ketamine-induced apoptosis follow similar developmental patterns, mostly comprised of layer V pyramidal neurons at P5 and shifting to mostly layer II to IV GABAergic neurons by P9. Changes in neuronal activity induced by the DREADD system bidirectionally regulated the pattern of ketamine-induced apoptosis, with reduced activity inducing increased apoptosis and shifting the lamination pattern to a more immature form. Importantly, rearing mice in an EE significantly reduced the magnitude of ketamine-induced apoptosis and shifted its developmental pattern to a more mature form. Together, these results demonstrate that lamination pattern and cell-type dependent vulnerability to ketamine-induced apoptosis follow the physiological apoptosis pattern and are age- and activity-dependent. Naturally elevating neuronal activity is a possible method for reducing the adverse effects of general anesthesia.
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Affiliation(s)
- Qi Wang
- Department of Anesthesiology and Intensive Care Medicine, Xinhua Hospital, College of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Feng-Yan Shen
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Rong Zou
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Jing-Jing Zheng
- Shanghai Information Center for Life Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Xiang Yu
- Institute of Neuroscience and State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China.
| | - Ying-Wei Wang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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21
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Rosenholm M, Paro E, Antila H, Võikar V, Rantamäki T. Repeated brief isoflurane anesthesia during early postnatal development produces negligible changes on adult behavior in male mice. PLoS One 2017; 12:e0175258. [PMID: 28380075 PMCID: PMC5381906 DOI: 10.1371/journal.pone.0175258] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/22/2017] [Indexed: 01/26/2023] Open
Abstract
Brain development is a complex process regulated by genetic programs and activity-dependent neuronal connectivity. Anesthetics profoundly alter neuronal excitability, and anesthesia during early brain development has been consistently associated with neuroapoptosis, altered synaptogenesis, and persistent behavioral abnormalities in experimental animals. However, the depth, and even more the duration and developmental time point(s) of exposure to anesthesia determine the neuropathological and long-term behavioral consequences of anesthetics. Here, we have investigated adulthood phenotypic changes induced by repeated but brief (30 min) isoflurane anesthesia delivered during two distinct developmental periods in male mice. A set of animals were subjected to anesthesia treatments at postnatal days 7, 8 and 9 (P7-9) when the animals are susceptible to anesthesia-induced neuroapoptosis and reduced synaptogenesis. To control the potential influence of (handling) stress, a separate group of animals underwent repeated maternal separations of similar durations. Another set of animals were exposed to the same treatments at postnatal days 15, 16 and 17 (P15-17), a developmental time period when anesthetics have been shown to increase synaptogenesis. Starting from postnatal week 9 the mouse phenotype was evaluated using a battery of behavioral tests that assess general locomotor activity (home cage activity, open field), learning and memory (water maze) and depression- (saccharin preference, forced swim test), anxiety- (light-dark box, stress-induced hyperthermia) and schizophrenia- (nesting, prepulse inhibition) related endophenotypes. Apart from mild impairment in spatial navigation memory, exposure to anesthesia treatments during P7-9 did not bring obvious behavioral alterations in adult animals. Importantly, maternal separation during the same developmental period produced a very similar phenotype during the water maze. Mice exposed to anesthesia during P15-17 showed mild hyperactivity and risk-taking behavior in adulthood, but were otherwise normal. We conclude that significantly longer administration periods are needed in order for early-life repeated exposures to anesthetics to produce behavioral alterations in adult mice.
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Affiliation(s)
- Marko Rosenholm
- Laboratory of Neurotherapeutics, Division of Physiology and Neuroscience, Faculty of Biological and Environmental Sciences, Department of Biosciences, University of Helsinki, Finland
| | - Emmi Paro
- Laboratory of Neurotherapeutics, Division of Physiology and Neuroscience, Faculty of Biological and Environmental Sciences, Department of Biosciences, University of Helsinki, Finland
| | - Hanna Antila
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Vootele Võikar
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Tomi Rantamäki
- Laboratory of Neurotherapeutics, Division of Physiology and Neuroscience, Faculty of Biological and Environmental Sciences, Department of Biosciences, University of Helsinki, Finland
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22
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Walters JL, Paule MG. Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity. Neurotoxicol Teratol 2017; 60:2-23. [DOI: 10.1016/j.ntt.2016.11.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 11/24/2022]
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Abstract
Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes. Additionally, in younger children, differences in pre-hospital response and the activation of developmental apoptosis may explain more severe outcomes after OHCA. These require us to consider whether present practices are in line with the science. The present recommendations for compression-only cardiopulmonary resuscitation in young adults, normothermia as opposed to hypothermia (33°C) after asphyxial arrests, and paramedic training are considered within this review in light of existing evidence. Modifications in present standards of care may help restore the benefits of youth after brain injury to the young survivor of OHCA.
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Affiliation(s)
- Brian Griffith
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cameron Dezfulian
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Clinical and Translational Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lin EP, Lee JR, Lee CS, Deng M, Loepke AW. Do anesthetics harm the developing human brain? An integrative analysis of animal and human studies. Neurotoxicol Teratol 2016; 60:117-128. [PMID: 27793659 DOI: 10.1016/j.ntt.2016.10.008] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/09/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
Anesthetics that permit surgical procedures and stressful interventions have been found to cause structural brain abnormalities and functional impairment in immature animals, generating extensive concerns among clinicians, parents, and government regulators regarding the safe use of these drugs in young children. Critically important questions remain, such as the exact age at which the developing brain is most vulnerable to the effects of anesthetic exposure, whether a particular age exists beyond which anesthetics are devoid of long-term effects on the brain, and whether any specific exposure duration exists that does not lead to deleterious effects. Accordingly, the present analysis attempts to put the growing body of animal studies, which we identified to include >440 laboratory studies to date, into a translational context, by integrating the preclinical data on brain structure and function with clinical results attained from human neurocognitive studies, which currently exceed 30 studies. Our analysis demonstrated no clear exposure duration threshold below which no structural injury or subsequent cognitive abnormalities occurred. Animal data did not clearly identify a specific age beyond which anesthetic exposure did not cause any structural or functional abnormalities. Several potential mitigating strategies were found, however, no general anesthetic was identified that consistently lacked neurodegenerative properties and could be recommended over other anesthetics. It therefore is imperative, to expand efforts to devise safer anesthetic techniques and mitigating strategies, even before long-term alterations in brain development are unequivocally confirmed to occur in millions of young children undergoing anesthesia every year.
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Affiliation(s)
- Erica P Lin
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Anesthesiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States
| | - Jeong-Rim Lee
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul 120-752, Republic of Korea
| | - Christopher S Lee
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Anesthesiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States
| | - Meng Deng
- Department of Anesthesiology, Huashan Hospital of Fudan University, Shanghai, China
| | - Andreas W Loepke
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Anesthesiology and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States; Neuroscience Program, University of Cincinnati, Cincinnati, OH 45267, United States.
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Mehta B, Hunt R, Walker K, Badawi N. Evaluation of Preoperative Amplitude-Integrated Electroencephalography (aEEG) Monitoring for Predicting Long-Term Neurodevelopmental Outcome Among Infants Undergoing Major Surgery in the Neonatal Period. J Child Neurol 2016; 31:1276-81. [PMID: 27287185 DOI: 10.1177/0883073816653781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 04/18/2016] [Indexed: 11/15/2022]
Abstract
The authors aimed to evaluate preoperative amplitude-integrated electroencephalography (aEEG) patterns for predicting neurodevelopmental outcome among infants undergoing major surgery in the neonatal period. They retrospectively reviewed the preoperative aEEG data of 58 neonates who had undergone major neonatal surgery between 2006 and 2008. The authors classified aEEGs using a weighted background score. Neurodevelopmental outcome was assessed at 3 years of age using the Bayley Scales of Toddler and Infant Development III. Over a third of infants (36%) showed an abnormal aEEG background. Seizure activity was identified in 11 (19%) infants. The majority (68%) of infants had developmental delay, with no significant differences between cardiac and other surgery groups. Logistic regression found no statistically significant but some clinically important associations between aEEG background and neurodevelopmental outcome. Comorbidity was associated with worse outcomes. While the predictive utility of aEEG in this population remains unclear, the findings suggest that further research is warranted.
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Affiliation(s)
- Bhavesh Mehta
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Rodney Hunt
- Department of Neonatal Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Karen Walker
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Owens C, Li BK, Thomas KE, Irwin MS. Surveillance imaging and radiation exposure in the detection of relapsed neuroblastoma. Pediatr Blood Cancer 2016; 63:1786-93. [PMID: 27304424 DOI: 10.1002/pbc.26099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/10/2016] [Accepted: 05/16/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND More than half of children with high-risk neuroblastoma (NB) will experience recurrence. Radiologic imaging is used for initial staging and during therapy to assess response. However, the role of surveillance imaging in the detection of relapse has not been well studied. Surveillance potentially results in high cumulative exposure to ionizing radiation, which may be associated with an increased risk of developing second malignancies. PROCEDURE We reviewed NB cases at our institution between 2000 and 2011. We calculated radiation exposure due to imaging (during diagnosis, treatment, and posttherapy surveillance) using cumulative effective dose (CED) estimates and determined whether cross-sectional imaging identified recurrences. RESULTS Fifty of 183 patients with NB experienced a recurrence. The median time from diagnosis to relapse was 1.20 years (range: 0.18-6.66 years). Most patients had evidence of metastases and only 4 of 50 patients presented with isolated primary tumor site recurrences. The mean CED prior to relapse was 125.2 mSv (range: 24.5-259.7), 64% of which was from computed tomography (CT) scans. Thirty-seven of 50 patients had clinically evident or measurable disease detected by X-ray (XR), ultrasound (US), or urinary catecholamines (UCats), and the addition of metaiodobenzylguanidine (MIBG) scans identified eight additional recurrences. Thus, cross-sectional imaging (CT/MRI, where MRI is magnetic resonance imaging) was only required to identify 10% (5/50) of cases. CONCLUSION Relapsed disease was detected in most patients by symptoms/exam, MIBG scan, UCats, and/or XR/US, supporting reduced use of CT imaging in posttherapy surveillance, thereby decreasing cumulative radiation dose. Refinement of surveillance imaging may be further guided by risk stratification, disease sites, and potentially biomolecular markers.
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Affiliation(s)
- Cormac Owens
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.,Department of Paediatric Haematology-Oncology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Bryan K Li
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Karen E Thomas
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meredith S Irwin
- Division of Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Napier ML, Armstrong DJ, McLoone SF, McLoone EM. Congenital Nasolacrimal Duct Obstruction: Comparison of Two Different Treatment Algorithms. J Pediatr Ophthalmol Strabismus 2016; 53:285-91. [PMID: 27486727 DOI: 10.3928/01913913-20160629-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To clarify the most appropriate treatment regimen for congenital nasolacrimal duct obstruction (CNLDO). METHODS A retrospective observational analysis was performed of patients undergoing probing with or without intubation to treat CNLDO in a single institution (Royal Victoria Hospital, Belfast) from 2006 to 2011. RESULTS Based on exclusion criteria, 246 eyes of 177 patients (aged 0 to 9.8 years with a mean age of 2.1 years) were included in this study: 187 (76%) eyes had successful outcome at first intervention with primary probing, whereas 56 (23%) eyes underwent secondary intervention. There were no significant differences by gender, age, or obstruction complexity between the successful and unsuccessful patients with first intervention. For those patients requiring secondary intervention, 16 of 24 (67%) eyes had successful probing, whereas 22 of 24 (92%) had successful intubation. Patients with intubation as a secondary procedure were significantly more likely to have a successful outcome (P = .037). Statistical analysis was performed using the Fisher's exact test and Barnard's exact test. CONCLUSIONS Primary probing for CNLDO has a high success rate that is not adversely affected by increasing age. This study also indicates that if initial probing is unsuccessful, nasolacrimal intubation rather than repeat probing yields a significantly higher success rate. [J Pediatr Ophthalmol Strabismus. 2016;53(5):285-291.].
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Creeley CE. From Drug-Induced Developmental Neuroapoptosis to Pediatric Anesthetic Neurotoxicity-Where Are We Now? Brain Sci 2016; 6:brainsci6030032. [PMID: 27537919 PMCID: PMC5039461 DOI: 10.3390/brainsci6030032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/05/2016] [Accepted: 08/12/2016] [Indexed: 01/02/2023] Open
Abstract
The fetal and neonatal periods are critical and sensitive periods for neurodevelopment, and involve rapid brain growth in addition to natural programmed cell death (i.e., apoptosis) and synaptic pruning. Apoptosis is an important process for neurodevelopment, preventing redundant, faulty, or unused neurons from cluttering the developing brain. However, animal studies have shown massive neuronal cell death by apoptosis can also be caused by exposure to several classes of drugs, namely gamma-aminobutyric acid (GABA) agonists and N-methyl-d-aspartate (NMDA) antagonists that are commonly used in pediatric anesthesia. This form of neurotoxic insult could cause a major disruption in brain development with the potential to permanently shape behavior and cognitive ability. Evidence does suggest that psychoactive drugs alter neurodevelopment and synaptic plasticity in the animal brain, which, in the human brain, may translate to permanent neurodevelopmental changes associated with long-term intellectual disability. This paper reviews the seminal animal research on drug-induced developmental apoptosis and the subsequent clinical studies that have been conducted thus far. In humans, there is growing evidence that suggests anesthetics have the potential to harm the developing brain, but the long-term outcome is not definitive and causality has not been determined. The consensus is that there is more work to be done using both animal models and human clinical studies.
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Affiliation(s)
- Catherine E Creeley
- Department of Psychology, State University of New York at Fredonia, Fredonia, NY 14063, USA.
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Voepel-Lewis T, Malviya S. Is Anesthesia Safe for My Child? J Perianesth Nurs 2016; 31:184-7. [DOI: 10.1016/j.jopan.2015.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/31/2015] [Indexed: 10/22/2022]
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Lithium Protects Against Anaesthesia Neurotoxicity In The Infant Primate Brain. Sci Rep 2016; 6:22427. [PMID: 26951756 PMCID: PMC4782073 DOI: 10.1038/srep22427] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 02/08/2016] [Indexed: 02/05/2023] Open
Abstract
Exposure of infant animals, including non-human primates (NHPs), to anaesthetic drugs causes apoptotic death of neurons and oligodendrocytes (oligos) and results in long-term neurodevelopmental impairment (NDI). Moreover, retrospective clinical studies document an association between anaesthesia exposure of human infants and significant increase in NDI. These findings pose a potentially serious dilemma because millions of human infants are exposed to anaesthetic drugs every year as part of routine medical care. Lithium (Li) at clinically established doses is neuroprotective in various cerebral injury models. We therefore investigated whether Li also protects against anaesthesia neurotoxicity in infant NHPs. On postnatal day 6 NHPs were anaesthetized with the widely used anaesthetic isoflurane (ISO) for 5 h employing the same standards as in a human pediatric surgery setting. Co-administration of Li completely prevented the acute ISO-induced neuroapoptosis and significantly reduced ISO-induced apoptosis of oligodendroglia. Our findings are highly encouraging as they suggest that a relatively simple pharmacological manipulation might protect the developing primate brain against the neurotoxic action of anaesthetic drugs while not interfering with the beneficial actions of these drugs. Further research is needed to determine Li’s potential to prevent long-term NDI resulting from ISO anaesthesia, and to establish its safety in human infants.
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Sabir H, Wood T, Gill H, Liu X, Dingley J, Thoresen M. Xenon depresses aEEG background voltage activity whilst maintaining cardiovascular stability in sedated healthy newborn pigs. J Neurol Sci 2016; 363:140-4. [PMID: 27000239 DOI: 10.1016/j.jns.2016.02.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/25/2016] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Changes in electroencephalography (EEG) voltage range are used to monitor the depth of anaesthesia, as well as predict outcome after hypoxia-ischaemia in neonates. Xenon is being investigated as a potential neuroprotectant after hypoxic-ischaemic brain injury, but the effect of Xenon on EEG parameters in children or neonates is not known. This study aimed to examine the effect of 50% inhaled Xenon on background amplitude-integrated EEG (aEEG) activity in sedated healthy newborn pigs. METHODS Five healthy newborn pigs, receiving intravenous fentanyl sedation, were ventilated for 24 h with 50%Xenon, 30%O2 and 20%N2 at normothermia. The upper and lower voltage-range of the aEEG was continuously monitored together with cardiovascular parameters throughout a 1 h baseline period with fentanyl sedation only, followed by 24 h of Xenon administration. RESULTS The median (IQR) upper and lower aEEG voltage during 1 h baseline was 48.0 μV (46.0-50.0) and 25.0 μV (23.0-26.0), respectively. The median (IQR) aEEG upper and lower voltage ranges were significantly depressed to 21.5 μV (20.0-26.5) and 12.0 μV (12.0-16.5) from 10 min after the onset of 50% Xenon administration (p=0.002). After the initial Xenon induced depression in background aEEG voltage, no further aEEG changes were seen over the following 24h of ventilation with 50% xenon under fentanyl sedation. Mean arterial blood pressure and heart rate remained stable. CONCLUSION Mean arterial blood pressure and heart rate were not significantly influenced by 24h Xenon ventilation. 50% Xenon rapidly depresses background aEEG voltage to a steady ~50% lower level in sedated healthy newborn pigs. Therefore, care must be taken when interpreting the background voltage in neonates also receiving Xenon.
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Affiliation(s)
- Hemmen Sabir
- School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom; Departments of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Düsseldorf, Heinrich-Heine University Düsseldorf, Germany
| | - Thomas Wood
- Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hannah Gill
- School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom
| | - Xun Liu
- School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom
| | - John Dingley
- College of Medicine, Swansea University, United Kingdom
| | - Marianne Thoresen
- School of Clinical Sciences, University of Bristol, St Michael's Hospital, Bristol, United Kingdom; Department of Physiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
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Abstract
BACKGROUND A wealth of data shows neuronal demise after general anesthesia in the very young rodent brain. Herein, the authors apply proton magnetic resonance spectroscopy (1HMRS), testing the hypothesis that neurotoxic exposure during peak synaptogenesis can be tracked via changes in neuronal metabolites. METHODS 1HMRS spectra were acquired in the brain (thalamus) of neonatal rat pups 24 and 48 h after sevoflurane exposure on postnatal day (PND) 7 and 15 and in unexposed, sham controls. A repeated measure ANOVA was performed to examine whether changes in metabolites were different between exposed and unexposed groups. Sevoflurane-induced neurotoxicity on PND7 was confirmed by immunohistochemistry. RESULTS In unexposed PND7 pups (N = 21), concentration of N-acetylaspartate (NAA; [NAA]) increased by 16% from PND8 to PND9, whereas in exposed PND7 pups (N = 19), [NAA] did not change and concentration of glycerophosphorylcholine and phosphorylcholine ([GPC + PCh]) decreased by 25%. In PND15 rats, [NAA] increased from PND16 to PND17 for both the exposed (N = 14) and the unexposed (N = 16) groups. Two-way ANOVA for PND7 pups demonstrated that changes over time observed in [NAA] (P = 0.031) and [GPC + PCh] (P = 0.024) were different between those two groups. CONCLUSIONS The authors demonstrated that normal [NAA] increase from PND8 to PND9 was impeded in sevoflurane-exposed rats when exposed at PND7; however, not impeded when exposed on PND15. Furthermore, the authors showed that noninvasive 1HMRS is sufficiently sensitive to detect subtle differences in developmental time trajectory of [NAA]. This is potentially clinically relevant because 1HMRS can be applied across species and may be useful in providing evidence of neurotoxicity in the human neonatal brain.
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Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT). J Cardiovasc Comput Tomogr 2015; 9:475-92. [DOI: 10.1016/j.jcct.2015.07.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/17/2015] [Indexed: 12/16/2022]
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Korpi ER, den Hollander B, Farooq U, Vashchinkina E, Rajkumar R, Nutt DJ, Hyytiä P, Dawe GS. Mechanisms of Action and Persistent Neuroplasticity by Drugs of Abuse. Pharmacol Rev 2015; 67:872-1004. [DOI: 10.1124/pr.115.010967] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Bajwa SJS, Anand S, Gupta H. Perils of paediatric anaesthesia and novel molecular approaches: An evidence-based review. Indian J Anaesth 2015; 59:272-81. [PMID: 26019351 PMCID: PMC4445148 DOI: 10.4103/0019-5049.156865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Evolution of anaesthesia has been largely helped by progress of evidence-based medicine. In spite of many advancements in anaesthesia techniques and availability of newer and safer drugs, much more needs to be explored scientifically for the development of anaesthesia. Over the last few years, the notion that the actions of the anaesthesiologist have only immediate or short-term consequences has largely been challenged. Evidences accumulated in the recent years have shown that anaesthesia exposure may have long-term consequences particularly in the extremes of ages. However, most of the studies conducted so far are in vitro or animal studies, the results of which have been extrapolated to humans. There have been confounding evidences linking anaesthesia exposure in the developing brain with poor neurocognitive outcome. The results of animal studies and human retrospective studies have raised concern over the potential detrimental effects of general anaesthetics on the developing brain. The purpose of this review is to highlight the long-term perils of anaesthesia in the very young and the potential of improving anaesthesia delivery with the novel molecular approaches.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
| | - Smriti Anand
- Department of Anaesthesiology and Intensive Care, Maharishi Markendeshwar Medical College and Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| | - Hemant Gupta
- Department of Paediatrics, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Epelman M, Johnson C, Hellinger JC, Darge K, Newman B. Vascular Lesions—Congenital, Acquired, and Iatrogenic: Imaging in the Neonate. Semin Ultrasound CT MR 2015; 36:193-215. [DOI: 10.1053/j.sult.2015.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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The biological cost of the depression of consciousness. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1016/j.rcae.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The biological cost of the depression of consciousness☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2015. [DOI: 10.1097/01819236-201543020-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Neira A, Aguirre LF, Gómez RM, Barbosa FR, Pérez JA, Muñoz AM. Effects of multiple exposures to sevoflurane at sub-MAC doses on neuroapoptosis and cognitive function during the neonatal period. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rcae.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Neira A, Aguirre LF, Gómez RM, Ríos Barbosa F, Pérez JA, Muñoz AM. Efectos de múltiples exposiciones a sevoflurano a dosis sub-CAM en la neuroapoptosis y la función cognitiva en el periodo neonatal. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1016/j.rca.2014.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Han BK, Vezmar M, Lesser JR, Michalak G, Grant K, Dassenko D, Maresh J, Overman DM. Selective use of cardiac computed tomography angiography: an alternative diagnostic modality before second-stage single ventricle palliation. J Thorac Cardiovasc Surg 2014; 148:1548-54. [PMID: 24930614 DOI: 10.1016/j.jtcvs.2014.04.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/26/2014] [Accepted: 04/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the accuracy and risk of substituting cardiac computed tomography for cardiac catheterization in select patients for evaluation of anatomy before second-stage single ventricle palliation. METHODS This is a retrospective review of consecutive diagnostic cardiac catheterization (n=16) and computed tomography studies (n=16) performed before second-stage single ventricle palliation from March 2010 to July 2012 at a single institution. Risk (anesthesia, vascular access, contrast, and radiation exposure), accuracy, and postoperative course were compared. Nonparametric analysis was used to compare differences in group medians. RESULTS General anesthesia was used for 16 of 16 cardiac catheterization studies and 1 of 16 computed tomography studies. Vascular access was central venous and/or arterial for all cardiac catheterization studies and a peripheral intravenous line for all computed tomography studies. Median age- and size-adjusted radiation dose was 14.0 mSv for cardiac catheterization and 1.1 mSv for computed tomography. Contrast dose was 4.8 mL/kg for the cardiac catheterization group and 2 mL/kg for the computed tomography group. There were no computed tomography discrepancies and 1 discrepancy between cardiac catheterization and surgical findings. There were 8 adverse events in 6 patients in the cardiac catheterization group and 1 adverse event in the computed tomography group. There was no difference between groups in postoperative course or need for repeat intervention. CONCLUSIONS Cardiac computed tomography and cardiac catheterization are equally accurate for evaluation of anatomy before second-stage single ventricle palliation when compared with surgical findings. Computed tomography may be the preferred test in select patients because of decreased vascular access and anesthesia risk, lower radiation and contrast exposure, and fewer adverse events.
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Affiliation(s)
- B Kelly Han
- Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minn; Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn; Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn.
| | - Marko Vezmar
- Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn
| | - John R Lesser
- Advanced Cardiac Imaging, Minneapolis Heart Institute and Foundation, Minneapolis, Minn
| | | | | | - David Dassenko
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
| | - Jill Maresh
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
| | - David M Overman
- Division of Cardiology and Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, Minn; Children's Hospitals and Clinics of Minnesota, Minneapolis, Minn
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Wise-Faberowski L, Quinonez ZA, Hammer GB. Anesthesia and the developing brain: relevance to the pediatric cardiac surgery. Brain Sci 2014; 4:295-310. [PMID: 24961762 PMCID: PMC4101478 DOI: 10.3390/brainsci4020295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/02/2014] [Accepted: 04/05/2014] [Indexed: 01/29/2023] Open
Abstract
Anesthetic neurotoxicity has been a hot topic in anesthesia for the past decade. It is of special interest to pediatric anesthesiologists. A subgroup of children potentially at greater risk for anesthetic neurotoxicity, based on a prolonged anesthetic exposure early in development, are those children receiving anesthesia for surgical repair of congenital heart disease. These children have a known risk of neurologic deficit after cardiopulmonary bypass for surgical repair of congenital heart disease. Yet, the type of anesthesia used has not been considered as a potential etiology for their neurologic deficits. These children not only receive prolonged anesthetic exposure during surgical repair, but also receive repeated anesthetic exposures during a critical period of brain development. Their propensity to abnormal brain development, as a result of congenital heart disease, may modify their risk of anesthetic neurotoxicity. This review article provides an overview of anesthetic neurotoxicity from the perspective of a pediatric cardiac anesthesiologist and provides insight into basic science and clinical investigations as it relates to this unique group of children who have been studied over several decades for their risk of neurologic injury.
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Affiliation(s)
- Lisa Wise-Faberowski
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
| | - Zoel A Quinonez
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
| | - Gregory B Hammer
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, CA 94305, USA.
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Affiliation(s)
- Tekoa L King
- From the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California at San Francisco, San Francisco, California; and Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Nemergut ME, Aganga D, Flick RP. Anesthetic neurotoxicity: what to tell the parents? Paediatr Anaesth 2014; 24:120-6. [PMID: 24283891 DOI: 10.1111/pan.12325] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 02/03/2023]
Abstract
Over the past decade, numerous preclinical and retrospective human studies have reported that the provision of anesthetic and sedative agents to infants and children may be associated with adverse neurodevelopmental outcomes. These data have gained widespread attention from professional and regulatory agencies, including the public at large. As such, pediatric anesthesiologists are being increasingly questioned by parents about the risks of anesthetic agents on their children's neurocognitive development. To impart a framework from which anesthesiologists may address the apprehensions of parents who actively bring up this issue, we review the data supporting anesthetic neurotoxicity and discuss its strengths and limitations. As many parents are not yet aware and do not actively raise these concerns, we also discuss whether such a conversation should be undertaken as a part of the consent process.
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Affiliation(s)
- Michael E Nemergut
- Departments of Anesthesiology and Pediatric and Adolescent Medicine, The Mayo Clinic, Rochester, MN, USA
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Effects of multiple exposures to sevoflurane at sub-MAC doses on neuroapoptosis and cognitive function during the neonatal period☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2014. [DOI: 10.1097/01819236-201442030-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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47
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Non-sedated, free breathing cardiac CT for evaluation of complex congenital heart disease in neonates. J Cardiovasc Comput Tomogr 2013; 7:354-60. [DOI: 10.1016/j.jcct.2013.11.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/04/2013] [Accepted: 11/03/2013] [Indexed: 01/19/2023]
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Abstract
This article describes the anesthetic management of pregnant women undergoing fetal surgery. Discussion includes general principles common to all fetal surgeries as well as specifics pertaining to open fetal surgery, minimally invasive fetal surgery, and ex utero intrapartum therapy (EXIT) procedures.
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Affiliation(s)
- Hans P Sviggum
- Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street Southwest, Rochester, MN 55905, USA.
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The Pandora's box of neonatal analgesia. Pediatr Neonatol 2013; 54:287. [PMID: 23643976 DOI: 10.1016/j.pedneo.2013.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 11/23/2012] [Accepted: 03/25/2013] [Indexed: 11/21/2022] Open
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50
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Xie Z. Neuronal vulnerability to anesthesia neurotoxicity depends on age of neurons. Ann Neurol 2013; 73:686-7. [PMID: 23595639 DOI: 10.1002/ana.23914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/01/2013] [Accepted: 04/12/2013] [Indexed: 12/16/2022]
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