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Li Z, Gan Y, Kang T, Zhao Y, Huang T, Chen Y, Liu J, Ke B. Camphor Attenuates Hyperalgesia in Neuropathic Pain Models in Mice. J Pain Res 2023; 16:785-795. [PMID: 36925623 PMCID: PMC10013580 DOI: 10.2147/jpr.s398607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Background The treatment of neuropathic pain is still a major troublesome clinical problem. The existing therapeutic drugs have limited analgesic effect and obvious adverse reactions, which presents opportunities and challenges for the development of new analgesic drugs. Camphor, a kind of monoterpene, has been shown anti-inflammatory and analgesic effects in traditional Chinese medicine. But we know little about its effect in neuropathic pain. In this article, We have verified the reliable analgesic effect of camphor in the neuropathic pain model caused by different predispositions. Methods The nociceptive response of mice was induced by transient receptor potential A1 (TRPA1) agonist to verify the effect of camphor on the nociceptive response. Multiple paclitaxel (PTX) injection models, Single oxaliplatin (OXA) injection models, Chronic constriction injury (CCI) models and Streptozotocin-induced (STZ) diabetic neuropathic pain models were used in this study. We verified the analgesic effect of camphor in mice by acetone test and conditioned place aversion test. At the same time, comparing the adverse reaction of nervous system between camphor and pregabalin at equivalent dose in locomotor activity test and rotarod test. Using patch clamp to verify the effect of camphor on dorsal root ganglion (DRG) excitability. Results In behavioral test, compared with vehicle group, camphor significantly reduced the spontaneous nociception caused by TRPA1 agonist-formalina and allyl isothiocyanate (AITC). Compared with vehicle group, camphor significantly reduced the flinching and licking time in neuropathic pain model mice, including PTX, OXA, STZ and CCI induced peripheral neuralgia models. Compared with vehicle group, pregabalin significantly increased the resting time and reduced the average speed without resting and distance in locomotor activity test, reduced the time stayed on rotarod in rotarod test. In patch clamp test, compared with vehicle group, camphor significantly reduced the action potential (AP) firing frequency of DRG. Conclusion Camphor can alleviate the symptoms of hyperalgesia in various neuropathic pain models, and has no obvious adverse reactions compared with pregabalin. This effect is related to the down-regulation of DRG neuron excitability.
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Affiliation(s)
- Ziyuan Li
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Gan
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ting Kang
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yi Zhao
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Tianguang Huang
- Frontiers Science Center for Disease-Related Molecular Network, Sichuan University West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yuhao Chen
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jin Liu
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Bowen Ke
- Department of Anesthesiology, Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Yang H, Yin Q, Huang L, Zhang M, Zhang X, Sun Q, Liu X, Wang Q, Yang X, Tan L, Ye M, Liu J. The Bioequivalence of Emulsified Isoflurane With a New Formulation of Emulsion: A Single-Center, Single-Dose, Double-Blinded, Randomized, Two-Period Crossover Study. Front Pharmacol 2021; 12:626307. [PMID: 33776768 PMCID: PMC7988084 DOI: 10.3389/fphar.2021.626307] [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: 11/05/2020] [Accepted: 01/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Emulsified isoflurane is a novel intravenous general anesthetic obtained by encapsulating isoflurane molecules into emulsion. The formulation of emulsion has been improved according to the latest regulations of the China Food and Drug Administration. This study was designed to compare the bioequivalence of the new and previous formulation emulsion of isoflurane. Methods: In a single-center, single-dose, double-blinded, randomized, two-period crossover study, healthy volunteers received intravenous injection of 30 mg/kg of isoflurane with either previous formulation of emulsion isoflurane (PFEI) or new formulation of emulsion isoflurane (NFEI). Arterial and venous blood samples were obtained for geometric mean test/reference ratios of Cmax, AUC0-t, and AUC0-∞, as well as their 90% confidence interval (CI90) as the primary outcome. The secondary outcomes were safety measurements such as vital signs, 12-lead electrocardiography, adverse effects, and laboratory tests; and anesthesia efficacy was assessed by Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) score, bispectral index (BIS), and loss/recovery of eyelash reflex. Results: 24 subjects were eligible, of which 21 completed the whole experiment (NFEI n = 21, PFEI n = 23). Arterial geometric mean test/reference ratios of Cmax, AUC0-t, and AUC0-∞ were 104.50% (CI90 92.81%–117.65%), 108.23% (94.51%–123.96%), and 106.53% (93.94%∼120.80%), respectively. The most commonly seen adverse effects for NFEI and PFEI were injection pain (38.1% vs. 34.8%), hypotension (19.0% vs. 13.0%), apnea (14.3% vs. 17.4%), and upper airway obstruction (14.3% vs. 13.0%). No severe adverse effect was observed. The effectiveness of general anesthesia was similar between the two formulations. Conclusion: The CI90 of Cmax, AUC0-t, AUC0-∞, NFEI, and PFEI were within the range of 80%–125%, suggesting bioequivalence between NFEI and PFEI. The safety and anesthesia effectiveness were also similar.
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Affiliation(s)
- Hui Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qinqin Yin
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Luying Huang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Min Zhang
- Clinical Research Center, Yichang Humanwell Pharmaceutical CO., LTD, Yichang, China
| | - Xinxin Zhang
- Clinical Research Center, Yichang Humanwell Pharmaceutical CO., LTD, Yichang, China
| | - Qirong Sun
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuewei Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingcan Tan
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Ye
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
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Morohashi T, Itakura S, Shimokawa KI, Ishii F, Sanjo Y, Kazama T. Anesthetic Potency of Intravenous Infusion of 20% Emulsified Sevoflurane and Effect on the Blood-Gas Partition Coefficient in Dogs. Anesth Analg 2021; 132:575-583. [PMID: 33105277 DOI: 10.1213/ane.0000000000005232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intravenous (IV) infusions of volatile anesthetics in lipid emulsion may increase blood lipid concentration, potentially altering the anesthetic agent's blood solubility and blood-gas partition coefficient (BGPC). We examined the influence of a low-lipid concentration 20% sevoflurane emulsion on BGPC, and the anesthetic potency of this emulsion using dogs. METHODS We compared BGPC and anesthetic characteristics in 6 dogs between the IV anesthesia of emulsion and the sevoflurane inhalation anesthesia in a randomized crossover substudy. Minimum alveolar concentrations (MACs) were determined by tail-clamp stimulation by using the up-and-down method. Blood sevoflurane concentration and partial pressure were measured by gas chromatography; end-tidal sevoflurane concentration was measured using a gas monitor. The primary outcome was BGPC at the end of IV anesthesia and inhalation anesthesia. Secondary outcomes were time to loss/recovery of palpebral reflex, finish intubation and awakening, MAC, blood concentration/partial pressure at MAC and awakening, correlation between blood partial pressure and gas monitor, and the safety of emulsions. RESULTS BGPC showed no difference between IV and inhaled anesthesia (0.859 [0.850-0.887] vs 0.813 [0.791-0.901]; P = .313). Induction and emergence from anesthesia were more rapid in IV anesthesia of emulsion than inhalation anesthesia. MAC of emulsion (1.33% [1.11-1.45]) was lower than that of inhalation (2.40% [2.33-2.48]; P = .031), although there was no significant difference in blood concentration. End-tidal sevoflurane concentration could be estimated using gas monitor during IV anesthesia of emulsion. No major complications were observed. CONCLUSIONS IV anesthesia with emulsion did not increase the BGCP significantly compared to inhalation anesthesia. It was suggested that the anesthetic potency of this emulsion may be equal to or more than that of inhalation.
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Affiliation(s)
- Toru Morohashi
- From the Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan
| | - Sayako Itakura
- From the Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan
| | - Ken-Ichi Shimokawa
- Department of Pharmaceutical Sciences, Meiji Pharmaceutical University, Kiyose, Japan
| | - Fumiyoshi Ishii
- Department of Pharmaceutical Sciences, Meiji Pharmaceutical University, Kiyose, Japan
| | - Yoshimitsu Sanjo
- From the Department of Anesthesiology, National Defense Medical College, Tokorozawa, Japan
| | - Tomiei Kazama
- Department of Anesthesia, Toyooka-Daiichi Hospital, Iruma, Japan
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Zhao X, Chang G, Cheng Y, Zhou Z. GABA A Receptor/STEP61 Signaling Pathway May Be Involved in Emulsified Isoflurane Anesthesia in Rats. Int J Mol Sci 2020; 21:E4078. [PMID: 32517358 PMCID: PMC7312199 DOI: 10.3390/ijms21114078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Emulsified isoflurane (EISO) is a type of intravenous anesthetic. How emulsified isoflurane works in the brain is still unclear. The aim of this study was to explore whether epigenetic mechanisms affect anesthesia and to evaluate the anesthetic effects of emulsified isoflurane in rats. (2) Methods: Rats were randomly divided into four groups (n = 8/group): The tail vein was injected with normal saline 0.1 mL·kg-1·min-1for the control (Con) group, with intralipid for the fat emulsion (FE) group, with EISO at 60 mg·kg-1·min-1 for the high-concentration (HD) group, and 45 mg·kg-1·min-1 for the low-concentration (LD) group. The consciousness state, motor function of limbs, and response to nociceptive stimulus were observed after drug administration. (3) Results: Using real-time polymerase chain reaction (PCR) to assess the promoter methylation of ion channel proteins in the cerebral cortex of rats anesthetized by EISO, we demonstrated that the change in the promoters' methylation of the coding genes for gamma-aminobutyric acid A receptor α1 subunit (GABAAα1), N-methyl-D-aspartate receptor subunit 1 (NMDAR1), and mu opioid receptor 1 (OPRM1) was accompanied by the change in messenger ribonucleic acid (mRNA) and protein expression by these genes. (4) Conclusion: These data suggest that the epigenetic factors' modulation might offer a novel approach to explore the anesthetic mechanism of EISO.
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Affiliation(s)
| | | | | | - Zhenlei Zhou
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Nanjing Agricultural University, Nanjing 210095, China; (X.Z.); (G.C.); (Y.C.)
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Löser B, Petzoldt M, Löser A, Bacon DR, Goerig M. Intravenous Regional Anesthesia: A Historical Overview and Clinical Review. J Anesth Hist 2019; 5:99-108. [PMID: 31570204 DOI: 10.1016/j.janh.2018.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 06/10/2023]
Abstract
Intravenous regional anesthesia (IVRA) is an established, safe and simple technique, being applicable for various surgeries on the upper and lower limbs. In 1908, IVRA was first described by the Berlin surgeon August Bier, hence the name "Bier's Block". Although his technique was effective, it was cumbersome and fell into disuse when neuroaxial and percutaneous plexus blockades gained widespread popularity in the early 20th century. In the 1960s, it became widespread, when the New Zealand anesthesiologist Charles McKinnon Holmes praised its use by means of new available local anesthetics. Today, IVRA is still popular in many countries being used in the emergency room, for outpatients and for high-risk patients with contraindications for general anesthesia. IVRA offers a favorable risk-benefit ratio, cost-effectiveness, sufficient muscle relaxation and a fast on- and offset. New upcoming methods for monitoring, specialized personnel and improved emergency equipment made IVRA even safer. Moreover, IVRA may be applied to treat complex regional pain syndromes. Prilocaine and lidocaine are considered as first-choice local anesthetics for IVRA. Also, various adjuvant drugs have been tested to augment the effect of IVRA, and to reduce post-deflation tourniquet pain. Since major adverse events are rare in IVRA, it is regarded as a very safe technique. Nevertheless, systemic neuro- and cardiotoxic side effects may be linked to an uncontrolled systemic flush-in of local anesthetics and must be avoided. This review gives a historical overview of more than 100 years of experience with IVRA and provides a current view of IVRA with relevant key facts for the daily clinical routine.
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MESH Headings
- Anesthesia, Conduction/history
- Anesthesia, Conduction/instrumentation
- Anesthesia, Conduction/methods
- Anesthesia, Intravenous/adverse effects
- Anesthesia, Intravenous/history
- Anesthesia, Intravenous/instrumentation
- Anesthetics, Local/adverse effects
- Anesthetics, Local/history
- Cocaine/administration & dosage
- Cocaine/history
- Contraindications, Procedure
- History, 19th Century
- History, 20th Century
- History, 21st Century
- Humans
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Affiliation(s)
- Benjamin Löser
- Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, University Medicine Rostock, Schillingallee 35, 18057 Rostock, Germany.
| | - Martin Petzoldt
- Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
| | - Anastassia Löser
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
| | - Douglas R Bacon
- Department of Anesthesiology, University of Mississippi, Medical Center, 2500 North State Street, Jackson, MS39216, USA.
| | - Michael Goerig
- Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
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Weldon C, Ji T, Nguyen MT, Rwei A, Wang W, Hao Y, Zhao C, Mehta M, Wang BY, Tsui J, Marini RP, Kohane DS. Nanoscale Bupivacaine Formulations To Enhance the Duration and Safety of Intravenous Regional Anesthesia. ACS NANO 2019; 13:18-25. [PMID: 30351910 DOI: 10.1021/acsnano.8b05408] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Intravenous regional anesthesia (IVRA; Bier block) is commonly used to anesthetize an extremity for surgery. Limitations of the procedure include pain from the required tourniquet, the toxicity that can occur from systemic release of local anesthetics, and the lack of postoperative pain relief. We hypothesized that the nanoencapsulation of the local anesthetic would prolong local anesthesia and enhance safety. Here, we developed an ∼15 nm micellar bupivacaine formulation (M-Bup) and tested it in a rat tail vein IVRA model, in which active agents were restricted in the tail by a tourniquet for 15 min. After tourniquet removal, M-Bup provided local anesthesia for 4.5 h, which was two times longer than that from a larger dose of free bupivacaine. Approximately 100 nm liposomal bupivacaine (L-Bup) with the same drug dose as M-Bup did not cause anesthesia. Blood levels of bupivacaine after tourniquet removal were lower in animals receiving M-Bup than L-Bup or free bupivacaine, demonstrating enhanced safety. Tissue reaction to M-Bup was benign.
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Affiliation(s)
- Christopher Weldon
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
- Department of Surgery , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Tianjiao Ji
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Minh-Thuy Nguyen
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Alina Rwei
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Weiping Wang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Yi Hao
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Chao Zhao
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Manisha Mehta
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Bruce Y Wang
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Jonathan Tsui
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
| | - Robert P Marini
- Division of Comparative Medicine , Massachusetts Institute of Technology , Cambridge , Massachusetts 02139 , United States
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology , Boston Children's Hospital, Harvard Medical School , Boston , Massachusetts 02115 , United States
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Stable perfluorocarbon emulsions for the delivery of halogenated ether anesthetics. Colloids Surf B Biointerfaces 2018; 172:797-805. [PMID: 30342412 DOI: 10.1016/j.colsurfb.2018.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Research into injectable volatile anesthetics has been ongoing for approximately 40 years, with limited success, in an attempt to address the deficiencies of inhalational anesthesia. The purpose of this work was to formulate and optimize volatile anesthetic carrier emulsions based on our prior work in perfluorocarbon emulsions. METHODS Perfluorocarbons were screened for their volatilty and emulsion stability. Optimal anesthetic emulsions were manufactured by high pressure homogenization of a select, clinically relevant perfluorocarbon, isoflurane and a surfactant-containing aqueous phase. Longitudinal particle size, polydispersity and isoflurane content analysis was performed. Observational studies of in vivo efficacy and safety were performed in 225-300 g Lewis Rats (n = 34) with blood chemistry and post study tissue pathology analysis. RESULTS Emulsion particle size and isolflurane content in select emulsions were stable at room temperature greater than 300 days. This stability was depedent on perfluorocarbon molecular weight and boiling point. in vivo, emulsions demonstrated a rapid onset and offset. Variability in onset metrics (loss of righting reflex, pain reflexes and time to recovery) was less than 40% amongst individual emulsion preparations (n = 9) utilized in induction trials. No adverse effects due to the intravenous administration of emulsions were observed in blood chemistry results or post-study pathological examination. CONCLUSIONS These formulations showed stability, safety and efficacy. In addition to induction and general anesthesia, these emulsions could have utility in global health or in military applications where equipment and resources are limited.
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Zhou C, Huang J, Yang Q, Li T, Liu J, Qian Z. Gold nanorods-based thermosensitive hydrogel produces selective long-lasting regional anesthesia triggered by photothermal activation of Transient Receptor Potential Vanilloid Type-1 channels. Colloids Surf B Biointerfaces 2018; 171:17-23. [PMID: 30005286 DOI: 10.1016/j.colsurfb.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/19/2018] [Accepted: 07/02/2018] [Indexed: 02/05/2023]
Abstract
Long-lasting regional anesthesia and selective sensory block are useful in post-operative analgesia and treatment of pathological pain. Previous studies have demonstrated that activation of TRPV1 (Transient Receptor Potential Vanilloid Type-1) channels facilitated the potency of QX-314 for selective long-lasting regional anesthesia in vivo. Hydrogel is a solid jelly-like material covering a wide range of properties from soft and weak to hard and tough. Gold nanorods are nanoparticles, which can be used for hyperthermia by exposure to near-infrared radiation. We fabricated a gold nanorods and QX-314 containing hydrogel. The molecular weight of hydrogel was adjusted to achieve a targeted phase transition temperature. Gold nanorods with a desired photothermal conversion efficacy and QX-314 were mixed with hydrogel to produce a gold nanorods-QX-314/hydrogel nanocomposite. A rat model of sciatic nerve block was applied to evaluate the regional anesthetic effect of the gold nanorods-QX-314/hydrogel nanocomposite. Upon exposure to near-infrared irradiation, the gold nanorods-QX-314/hydrogel nanocomposite activated TRPV1 channels through photothermal conversion and release of QX-314 at the same time. The gold nanorods and QX-314 loaded hydrogel exhibited a long-lasting regional anesthetic effect with selective sensory function block. Sensory block duration of the nanocomposite was significantly longer than of 1% lidocaine (90.0 ± 12.2 vs. 37.5 ± 12.5 min, P < 0.01). Motor block by the nanocomposite was observed for only 40% of rats with significantly shorter duration than its sensory block (42.5 ± 17.1 vs. 90.0 ± 12.2 min, P < 0.01). The gold nanorods-QX-314/hydrogel nanocomposite can produce a selective long-lasing regional anesthetic effect in a rat model of sciatic nerve block.
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Affiliation(s)
- Cheng Zhou
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, and Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, PR China
| | - Jianqiong Huang
- Department of Burn and Plastic Surgery, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, PR China
| | - Qian Yang
- School of Pharmacy, College Key Laboratory of Sichuan Province for Specific Structure of Small Molecule Drugs, Chengdu Medical College, Sichuan, Chengdu, 610500, PR China.
| | - Tao Li
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, and Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, PR China; West China-Washington Mitochondria and Metabolism Center, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, PR China.
| | - Jin Liu
- Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, and Department of Anesthesiology, West China Hospital of Sichuan University, Sichuan, Chengdu, 610041, PR China
| | - Zhiyong Qian
- State Key Laboratory and Collaborative Innovation Center of Biotherapy, Sichuan University, Chengdu, 610041, Sichuan, PR China
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Tanious MK, Beutler SS, Kaye AD, Urman RD. New Hypnotic Drug Development and Pharmacologic Considerations for Clinical Anesthesia. Anesthesiol Clin 2017; 35:e95-e113. [PMID: 28526163 DOI: 10.1016/j.anclin.2017.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Since the public demonstration of ether as a novel, viable anesthetic for surgery in 1846, the field of anesthesia has continually sought the ideal anesthetic-rapid onset, potent sedation-hypnosis with a high therapeutic ratio of toxic dose to minimally effective dose, predictable clearance to inactive metabolites, and minimal side effects. This article aims to review current progress of novel induction agent development and provide an update on the most promising drugs poised to enter clinical practice. In addition, the authors describe trends in novel agent development, implications for health care costs, and implications for perioperative care.
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Affiliation(s)
- Mariah Kincaid Tanious
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Sascha S Beutler
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Alan D Kaye
- Department of Anesthesiology and Pain Medicine, Louisiana State University School of Medicine, LSU Health Science Center, 1542 Tulane Avenue, Room 659, New Orleans, LA 70112, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Buys M, Scheepers PA, Levin AI. Lipid emulsion therapy: non-nutritive uses of lipid emulsions in anaesthesia and intensive care. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2015. [DOI: 10.1080/22201181.2015.1095470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhou C, Liang P, Liu J, Zhang W, Liao D, Chen Y, Chen X, Li T. Emulsified isoflurane enhances thermal transient receptor potential vanilloid-1 channel activation-mediated sensory/nociceptive blockade by QX-314. Anesthesiology 2014; 121:280-9. [PMID: 24667830 DOI: 10.1097/aln.0000000000000236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND QX-314 produces nociceptive blockade, facilitated by permeation through transient receptor potential vanilloid-1 (TRPV1) channels. TRPV1 channel can be activated by noxious heat and sensitized by volatile anesthetics. The authors hypothesized that emulsified isoflurane (EI) could enhance thermal TRPV1 channel activation-mediated sensory/nociceptive blockade by QX-314. METHODS Rats were perineurally injected with QX-314 (Sigma-Aldrich Co. Ltd. Shanghai, China) alone or QX-314 combined with EI, followed by heat exposure on the injection site. The tail-flick and tail-clamping tests were used to assess sensory and nociceptive blockade, respectively; a sciatic nerve block model was used to assess motor and sensory blockade. Effects of EI on thermal activation of TRPV1 channels were evaluated on rat dorsal root ganglia neurons by whole-cell patch-clamp recordings. RESULTS Heat exposure enhanced sensory/nociceptive blockade by QX-314 in rat tails, but not motor blockade in sciatic nerve block model. QX-314 alone or QX-314 + 42°C produced no nociceptive blockade. QX-314 + 48°C produced 100% nociceptive blockade with duration of 12.5 ± 2.0 h (mean ± SEM). By adding 2% EI, QX-314 + 42°C produced 80% nociceptive blockade with duration of 8.1 ± 1.9 h, which was similar to the effect of QX-314 + 46°C (7.7 ± 1.1 h; P = 0.781). The enhancement of heat on sensory/nociceptive blockade of QX-314 was prevented by TRPV1 channel antagonist. The temperature thresholds of TRPV1 channel activation on dorsal root ganglia neurons were significantly reduced by EI. CONCLUSIONS Thermal activation of TRPV1 channels enhanced long-lasting sensory/nociceptive blockade by QX-314 without affecting motor blockade. The addition of EI reduced temperature thresholds for inducing long-lasting sensory/nociceptive blockade due to QX-314.
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Affiliation(s)
- Cheng Zhou
- From the Laboratory of Anesthesia and Critical Care Medicine (C.Z., J.L., W.Z., D.L., Y.C., X.C., T.L.), Department of Anesthesiology (P.L., J.L., W.Z., X.C.), Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China
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The quaternary lidocaine derivative QX-314 produces long-lasting intravenous regional anesthesia in rats. PLoS One 2014; 9:e99704. [PMID: 24932639 PMCID: PMC4059684 DOI: 10.1371/journal.pone.0099704] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/18/2014] [Indexed: 02/05/2023] Open
Abstract
Background The lidocaine derivative, QX-314, produces long-lasting regional anesthesia in various animal models. We designed this study to examine whether QX-314 could produce long-lasting intravenous regional anesthesia (IVRA) in a rat model. Methods IVRA was performed on tail of rats. EC50 (median effective concentration) of QX-314 in IVRA was determined by up-and-down method. IVRA on tail of rats was evaluated by tail-flick and tail-clamping tests. For comparison between QX-314 and lidocaine, 60 Sprague-Dawley rats were randomly divided into 6 groups (n = 10/group), respectively receiving 0.5 ml of 0.5% lidocaine, 0.25% QX-314, 0.5% QX-314, 1.0% QX-314, 2.0% QX-314 and normal saline. To explore the role of TRPV1 channel in IVRA of QX-314, 20 rats were randomly divided into 2 groups (n = 10/group), respectively receiving 0.5 ml of 1% QX-314 and 1% QX-314+75 µg/ml capsazepine. Toxicities of QX-314 on central nervous system and cardiac system were measured in rats according to Racine's convulsive scale and by electrocardiogram, respectively. Results QX-314 could produce long-lasting IVRA in a concentration-dependent manner. EC50 of QX-314 in rat tail IVRA was 0.15±0.02%. At concentration of 0.5%, IVRA duration of QX-314 (2.5±0.7 hour) was significantly longer than that of 0.5% lidocaine (0.3±0.2 hour, P<0.001). TRPV1 channel antagonist (capsazepine) could significantly reduce the effect of QX-314. For evaluation of toxicities, QX-314 at doses of 5 or 10 mg/kg did not induce any serious complications. However, QX-314 at dose of 20 mg/kg (1% QX-314 0.5 ml for a rat weighing 250 g) induced death in 6/10 rats. Conclusions QX-314 could produce long-lasting IVRA in a concentration-dependent manner. This long-lasting IVRA was mediated by activation of TRPV1 channels. Evaluation of toxic complications of QX-314 confirmed that low but relevant doses of QX-314 did not result in any measurable toxicity.
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Zhou C, Huang H, Liu J, Wang X, Chen X, Zhang W. Emulsified isoflurane increases convulsive thresholds of lidocaine and produces neural protection after convulsion in rats. Anesth Analg 2014; 118:310-317. [PMID: 24445632 DOI: 10.1213/ane.0000000000000065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Local anesthetic-induced convulsions remain a concern of anesthesiologists when performing regional anesthesia. Our previous study found that the lidocaine requirement for IV regional anesthesia was reduced with coadministration of emulsified isoflurane. We designed this study to examine whether emulsified isoflurane could increase the convulsive threshold of lidocaine and produce protection after a lidocaine-induced convulsion. METHODS In experiment 1, the median convulsive dose of lidocaine with or without the addition of emulsified isoflurane was determined using the up-and-down method. In experiment 2, emulsified isoflurane (0.032 mL/kg for isoflurane), midazolam (1.6 mg/kg), 30% Intralipid (solvent of emulsified isoflurane) or saline was infused to treat lidocaine-induced convulsions, respectively. Convulsive behavior was scored by the modified Racine scale. Cognitive function and the pathology of hippocampus cornu ammonis 3 pyramid neurons of rats were evaluated on days 1, 3, 5, and 7 after convulsions. RESULTS In experiment 1, the median convulsive dose of lidocaine alone producing convulsions was 18.7 ± 2.6 mg/kg, and it was increased to 22.7 ± 2.6 (P = 0.010) and 26.7 ± 2.6 mg/kg (P < 0.001) with coadministration of emulsified isoflurane at doses of 0.016 and 0.032 mL/kg isoflurane, respectively. In experiment 2, both emulsified isoflurane and midazolam significantly suppressed lidocaine-induced tonic-clonic seizures. Rats treated with emulsified isoflurane regained full consciousness (convulsive score = 0) significantly earlier than rats treated with midazolam (8.7 ± 2.4 vs 19.5 ± 3.9 minutes, P < 0.001). Cognitive impairment and hippocampus cornu ammonis 3 pyramid neuron abnormalities were found after convulsions and improved with the administration of both emulsified isoflurane and midazolam. CONCLUSION Emulsified isoflurane increased the convulsive threshold of lidocaine and preserved neurological function in rats experiencing lidocaine-induced convulsions.
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Affiliation(s)
- Cheng Zhou
- From the Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University; Department of Anesthesiology, West China Second Hospital of Sichuan University; and Department of Anesthesiology, Laboratory of Anesthesia & Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China
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A Phase I, Dose-escalation Trial Evaluating the Safety and Efficacy of Emulsified Isoflurane in Healthy Human Volunteers. Anesthesiology 2014; 120:614-25. [PMID: 24162462 DOI: 10.1097/aln.0000000000000044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Abstract
Background
This first-in-human volunteer phase I clinical trial aimed to evaluate the safety, tolerability, and anesthesia efficacy of emulsified isoflurane (EI), an intravenously injectable formulation of isoflurane.
Methods
Seventy-eight healthy volunteers were recruited in this open-label, single-bolus, dose-escalation, phase I trial and were allocated into 16 cohorts. Each volunteer received a single bolus injection of EI. The dose started with 0.3 mg/kg (for isoflurane) and was planned to end with 64.6 mg/kg. Postdose vital signs, physical examination, laboratory tests, chest radiograph, 12-lead electrocardiogram, and development of any adverse event were closely monitored as safety measurements. Effectiveness in producing sedation/anesthesia was assessed by Modified Observer’s Assessment of Alertness/Sedation and Bispectral Index.
Results
The dose escalation ended as planned. The most common adverse events associated with EI were injection pain (77 of 78, 98.7%) and transient tachycardia (22 of 78, 25.6%). Only at high doses (≥38.3 mg/kg) did EI cause transient hypotension (5 of 78, 6.4%) or apnea (11 of 78, 14.1%), but all the affected volunteers recovered uneventfully. Fast onset of unconsciousness (typically 40 s after injection) was developed in all volunteers receiving doses of 22.6 mg/kg or greater. Waking-up time and depression in Modified Observer’s Assessment of Alertness/Sedation correlated well with EI dose. None of the postdose tests revealed any abnormal result.
Conclusions
EI is safe for intravenous injection in human volunteers in the dose range of 0.3 to 64.6 mg/kg. At doses of 22.6 mg/kg or higher, EI produced rapid onset of unconsciousness in all volunteers followed by fast, predictable, and complete recovery.
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Pharmacokinetics of intravenous emulsified isoflurane in beagle dogs. Br J Anaesth 2013; 110:128-36. [DOI: 10.1093/bja/aes311] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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A novel intravenous general anesthetic — emulsified isoflurane: from bench to bedside. Front Med 2012; 6:381-7. [DOI: 10.1007/s11684-012-0229-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
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Inhibition of voltage-gated sodium channels by emulsified isoflurane may contribute to its subarachnoid anesthetic effect in beagle dogs. Reg Anesth Pain Med 2012; 36:553-9. [PMID: 21989153 DOI: 10.1097/aap.0b013e3182324d18] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Volatile anesthetics, in addition to their general anesthesia action, have been proven to produce regional anesthetic effect in various animal models. The major aim of this study was to examine whether emulsified isoflurane (EI) could also produce subarachnoid anesthesia and to investigate its possible mechanism. METHODS Beagle dogs were randomly assigned into 5 groups (n = 6/group): intrathecally receiving 1% lidocaine 0.1 mL/kg, 30% intralipid 0.1 mL/kg (control), or 8% EI at doses of 0.05, 0.075, or 0.1 mL/kg, respectively. Consciousness state, motor function of limbs, and response to nociceptive stimulus were observed after drug administration. The effect of EI on voltage-gated Na channel was recorded from isolated spinal neurons of rats, using the whole-cell patch-clamp technique. Inhibition of peak sodium currents and effect of EI on Na channel gating were analyzed. RESULTS Emulsified isoflurane produced subarachnoid anesthesia in a dose-dependent manner, and at the dose of 0.1 mL/kg, the effect of 8% EI was similar to 1% lidocaine. Sodium channel currents were inhibited by EI at clinically relevant concentrations, with the IC50 (median inhibitory concentration) at 0.69 ± 0.08 mM. Voltage activation of Na channels was positive, shifted by isoflurane at the concentration of 0.77 mM, and V½ of activation (voltage for half-maximal activation) shifted from -12.4 ± 2.7 mV to -7.3 ± 2.3 mV (P < 0.01). CONCLUSIONS Emulsified isoflurane produced dose-dependent subarachnoid anesthesia, and this effect might be mediated by inhibition of EI on voltage-gated Na channels in the spinal cord.
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