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Li R, Zhang Y, Zhu Q, Wu Y, Song W. The role of anesthesia in peri‑operative neurocognitive disorders: Molecular mechanisms and preventive strategies. FUNDAMENTAL RESEARCH 2024; 4:797-805. [PMID: 39161414 PMCID: PMC11331737 DOI: 10.1016/j.fmre.2023.02.007] [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: 10/11/2022] [Revised: 12/21/2022] [Accepted: 02/15/2023] [Indexed: 03/18/2023] Open
Abstract
Peri-operative neurocognitive disorders (PNDs) include postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). Children and the elderly are the two populations most vulnerable to the development of POD and POCD, which results in both high morbidity and mortality. There are many factors, including neuroinflammation and oxidative stress, that are associated with POD and POCD. General anesthesia is a major risk factor of PNDs. However, the molecular mechanisms of PNDs are poorly understood. Dexmedetomidine (DEX) is a useful sedative agent with analgesic properties, which significantly improves POCD in elderly patients. In this review, the current understanding of anesthesia in PNDs and the protective effects of DEX are summarized, and the underlying mechanisms are further discussed.
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Affiliation(s)
- Ran Li
- The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Yun Zhang
- The National Clinical Research Center for Geriatric Disease, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Qinxin Zhu
- The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
| | - Yili Wu
- The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou 325000, China
| | - Weihong Song
- The Second Affiliated Hospital and Yuying Children's Hospital, Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, Wenzhou 325035, China
- The National Clinical Research Center for Geriatric Disease, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou 325000, China
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Long DA, Gibbons KS, Stocker C, Ranger M, Alphonso N, Le Marsney R, Dow B, Schults JA, Graydon C, Shehabi Y, Schibler A. Perioperative dexmedetomidine compared to midazolam in children undergoing open-heart surgery: A pilot randomised controlled trial. CRIT CARE RESUSC 2023; 25:33-42. [PMID: 37876986 PMCID: PMC10581262 DOI: 10.1016/j.ccrj.2023.04.007] [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: 10/26/2023]
Abstract
Objective There is a need for evidence on the best sedative agents in children undergoing open heart surgery for congenital heart disease. This study aimed to evaluate the feasibility and safety of dexmedetomidine in this group compared with midazolam. Design Double blinded, pilot randomized controlled trial. Setting Cardiac operating theatre and paediatric intensive care unit in Brisbane, Australia. Participants Infants (≤12 months of age) undergoing their first surgical repair of a congenital heart defect. Interventions Dexmedetomidine (up to 1.0mcg/kg/hr) versus midazolam (up to 80mcg/kg/hr), commenced in the cardiac operating theatre prior to surgery. Main outcome measures The primary outcome was the time spent in light sedation (Sedation Behavior Scale [SBS] -1 to +1); Co-primary feasibility outcome was recruitment, retention and protocol adherence. Secondary outcomes were use of supplemental sedatives, ventilator free days, delirium, vasoactive drug support, and adverse events. Neurodevelopment and health-related quality of life (HRQoL) were assessed at 12 months post-surgery. Results Sixty-six participants were recruited. The number of SBS scores in the light sedation range were greater in the dexmedetomidine group at 24 hours, 48 hours, and overall study duration (0-14 days) versus the midazolam group (24hr: 76/170 [45%] vs 60/178 [34%], aOR 4.14 [95% CI 0.48, 35.92]; 48hr: 154/298 [52%] vs 122/314 [39%], aOR 6.95 [95% CI 0.77, 63.13]; 0-14 days: 597/831 [72%] vs 527/939 [56%], aOR 3.93 [95% CI 0.62, 25.03]). Feasibility was established with no withdrawals or loss to follow-up at 14 days and minimal protocol deviations. There were no differences between the groups relating to clinical, safety, neurodevelopment or HRQoL outcomes. Conclusions The use of dexmedetomidine was associated with more time spent in light sedation when compared with midazolam. The feasibility of conducting a blinded RCT of midazolam and dexmedetomidine in children undergoing open heart surgery was also established. The findings justify further investigation in a larger trial. Clinical trial registration ACTRN12615001304527.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Australia
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Kristen S. Gibbons
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Christian Stocker
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
| | - Michael Ranger
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Australia
| | - Nelson Alphonso
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
- Department of Cardiac Surgery, Queensland Children's Hospital, Australia
| | - Renate Le Marsney
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
| | - Belinda Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Australia
| | - Jessica A. Schults
- Paediatric Intensive Care Unit, Queensland Children's Hospital, Australia
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Australia
| | - Cameron Graydon
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Australia
| | - Yahya Shehabi
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Andreas Schibler
- Wesley Medical Research Institute, Australia
- Critical Care Research Group, St. Andrew's War Memorial Hospital, Australia
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Wu Y, Cai Z, Cheng J, Zhang B, Wang G, Li W, Zhang Z. An adult female patient with single atrium and single ventricle undergoing appendectomy: A case report. Front Cardiovasc Med 2023; 10:1110269. [PMID: 36818334 PMCID: PMC9936086 DOI: 10.3389/fcvm.2023.1110269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Appendicitis is one of the common diseases, and appendectomy is one of the most commonly performed procedures. Single atrium and single ventricle are rare heart diseases, and very few patients survive to adulthood. We report a patient with single atrial and single ventricles undergoing appendectomy with transverse abdominis plane block and dexmedetomidine sedation anesthesia with smooth postoperative appendectomy.
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Affiliation(s)
- Yu Wu
- Department of Anesthesiology, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China
| | - Zenghua Cai
- Department of Anesthesiology, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China
| | - Jianzheng Cheng
- Department of Anesthesiology, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China
| | - Bo Zhang
- Department of General Surgery, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China
| | - Guoji Wang
- Department of Anesthesiology, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China
| | - Wei Li
- Department of General Surgery, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China,Wei Li,
| | - Zaiwang Zhang
- Department of Anesthesiology, The 980th Hospital (Bethune International Peace Hospital) of the Joint Logistic Support Force, Shijiazhuang, China,*Correspondence: Zaiwang Zhang,
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Zhao W, Song S, Chu W, Li Y, Chen S, Ji Y, Chen Q, Jin X, Ji F. Disruption of hippocampal P2RX2/CaMKII/NF-κB signaling contributes to learning and memory impairment in C57BL/6 mice induced by surgery plus anesthesia in neonatal period. Biomed Pharmacother 2022; 149:112897. [PMID: 35378503 DOI: 10.1016/j.biopha.2022.112897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
A great number of pediatric patients undergoing varied procedures make neonatal surgery plus anesthesia become a matter of great concern owing to underlying neurotoxicity in developing brain. The authors set out to assess long-term effects of surgery plus anesthesia in mouse model. Six-day-old C57BL/6 mice were randomized to receive either anesthesia with 3% sevoflurane, abdominal surgery under the same anesthesia, or the control condition. These mice were examined of learning and memory at juvenile age in Morris water maze test. The brain tissues of mice were harvested for Western blot analysis, including purinergic receptors P2X family, CaMKII and NF-κB. Another battery of mice were administered with inhibitors of P2RX2/3 (e.g., A317491) into hippocampal dentate gyrus before behavioral testing. We found that neonatal surgery plus anesthesia, but not sevoflurane anesthesia alone, impaired the learning and memory of juvenile mice, as evidenced by delayed escape latency and reduced platform-crossing times. Immunoblotting analysis showed that behavioral abnormalities were associated with increased levels of P2RX2, phosphorylated-CaMKIIβ and activated NF-κB in mouse hippocampus. Injection of A317491 ameliorated the impaired learning and memory of juvenile mice undergoing neonatal surgery plus anesthesia, and it also mitigated the neonatal surgery-induced signaling enhancement of P2RX2/CaMKII/NF-κB. Together, these results indicate that neonatal surgery plus anesthesia may cause long-term cognitive dysfunction, with potential mechanism of increasing P2RX2 and downstream signaling of phosphorylated-CaMKII and NF-κB. Our findings will promote more studies to assess detrimental effects of surgery and accompanying inflammation, diverse anesthetics and even sleeping deprivation on mouse neurodevelopment and neurobehavioral performance.
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Affiliation(s)
- Weiming Zhao
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou 215006, PR China; Institute of Anesthesiology, Soochow University, Suzhou 215006, PR China
| | - Shaoyong Song
- Institute of Anesthesiology, Soochow University, Suzhou 215006, PR China; Department of Pain Medicine, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215124, PR China
| | - Wei Chu
- Suzhou Medical College of Soochow University, Suzhou 215123, PR China
| | - Yixuan Li
- Suzhou Medical College of Soochow University, Suzhou 215123, PR China
| | - Shiwen Chen
- Suzhou Medical College of Soochow University, Suzhou 215123, PR China
| | - Yumeng Ji
- Suzhou Medical College of Soochow University, Suzhou 215123, PR China
| | - Qingcai Chen
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou 215006, PR China; Institute of Anesthesiology, Soochow University, Suzhou 215006, PR China
| | - Xin Jin
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou 215006, PR China; Institute of Anesthesiology, Soochow University, Suzhou 215006, PR China.
| | - Fuhai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou 215006, PR China; Institute of Anesthesiology, Soochow University, Suzhou 215006, PR China.
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Morton SU, Labrecque M, Moline M, Hansen A, Leeman K. Reducing Benzodiazepine Exposure by Instituting a Guideline for Dexmedetomidine Usage in the NICU. Pediatrics 2021; 148:e2020041566. [PMID: 34610948 DOI: 10.1542/peds.2020-041566] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Midazolam is a benzodiazepine sedative used in NICUs. Because benzodiazepine's effects include respiratory depression and potential detrimental developmental effects, minimizing exposure could benefit neonates. Dexmedetomidine is routinely used for sedation in older pediatric populations. We implemented a quality improvement initiative with the aim of decreasing midazolam infusions by 20% through use of dexmedetomidine. METHODS A multidisciplinary committee created a sedation guideline that included standardized dexmedetomidine dosing escalation and weaning. Baseline data collection occurred from January 2015 to February 2018, with intervention from March 2018 to December 2019. Percentage of sedation episodes with dexmedetomidine initiated was followed as a process measure. Outcomes measures were percentage of eligible infants receiving midazolam infusions and midazolam-free days per sedation episode. Bradycardia with dexmedetomidine, unplanned extubation rates, and morphine dosage were monitored as balancing measures. RESULTS Our study included 434 episodes of sedation in 386 patients. Dexmedetomidine initiation increased from 18% to 49%. The intervention was associated with a significant reduction in midazolam initiation by 30%, from 95% to 65%, with special cause variation on statistical process control chart analysis. Midazolam-free days per sedation episode increased from 0.3 to 2.2 days, and patients receiving dexmedetomidine had lower midazolam doses (1.3 mg/kg per day versus 2.2 mg/kg per day, P = 5.97 × 10-04). Bradycardia requiring discontinuation of dexmedetomidine, unplanned extubation rates, and morphine doses were unchanged. CONCLUSIONS Implementation of a quality improvement initiative was successful in reducing the percentage of patients receiving midazolam infusions and increased midazolam-free days per sedation episode, revealing an overall reduction in benzodiazepine exposure while maintaining adequate sedation.
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Affiliation(s)
- Sarah U Morton
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Michelle Labrecque
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Mark Moline
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Anne Hansen
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Kristen Leeman
- Division of Newborn Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
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The Influence of Different Dexmedetomidine Doses on Cognitive Function at Early Period of Patients Undergoing Laparoscopic Extensive Total Hysterectomy. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3531199. [PMID: 34621501 PMCID: PMC8492256 DOI: 10.1155/2021/3531199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/08/2021] [Accepted: 08/16/2021] [Indexed: 01/05/2023]
Abstract
Background This study aims to analyze the influence of different dexmedetomidine doses on cognitive function. It works on early periods of patients undergoing laparoscopic extensive total hysterectomy. Method 119 patients with gynecological cancer underwent a laparoscopic extensive total hysterectomy. The operation was performed at the Affiliated Women's and Children's Hospital of Xiamen University from January 2019 to June 2020. The score of MoCA and the level of TNF-α, IL-6, S-100β protein, NSE, and GFAP of each group were compared 1 day before and after operation and 3 and 7 days after operation. Result In four groups, remifentanil, sufentanil, and propofol were given in the following order: group A > group D > group C > group B. Group A > group D > group C in terms of time spent in the recovery room, extubation, and recovery from anesthesia. The difference between groups B and C was not significant (P > 0.05). Compared with group A, group B scored higher in MoCA at 1 day (T1), 3 days (T2), and 7 days (T3) after operation (P < 0.05). At the same scoring point, the score was group B > group C > group D > group A. The POCD of four groups all occurred at 3 days after surgery. Compared with the T0 point, the level of TNF-α and IL-6 of the four groups at T1 and T2 was significantly increased (P < 0.05). At T3, the level of TNF-α and IL-6 gradually decreased. At various periods, the levels of S-100 protein, NSE, and GFAP in groups B, C, and D were lower than those in group A (P0.05). Group B had a substantially higher rate of bradycardia than the other three groups (P0.05). The incidence of chills, respiratory depression, and restlessness in group A differed significantly from the other three groups (P < 0.05). Conclusion Using 0.5 μg/kg dexmedetomidine during the perianaesthesia can effectively reduce anesthetic drugs in patients. They had a laparoscopic extensive complete hysterectomy, which helps to reduce the adverse responses and the occurrence of POCD while also protecting brain function.
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Zheng BH, Liu XM, Zhao P, Li P. A review on neurodevelopmental abnormalities in congenital heart disease: focus on minimizing the deleterious effects on patients. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1899992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bai-hong Zheng
- Department of Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin, People’s Republic of China
| | - Xiu-min Liu
- Department of Clinical Laboratory, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Peng Zhao
- Department of Anesthesiology, the Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Ping Li
- Department of Developmental Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin, People’s Republic of China
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