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Zhang Y, Yan F, Wang Q, Wang Y, Huang L. Pre-anesthetic brain network metrics as predictors of individual propofol sensitivity. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108447. [PMID: 39366070 DOI: 10.1016/j.cmpb.2024.108447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/03/2024] [Accepted: 09/27/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Numerous factors, including demographic characteristics, have been implicated in modulating individual sensitivity to propofol; however, substantial inter-individual differences persist even after accounting for these factors. This study thus aimed to explore whether pre-anesthesia brain functional network metrics correlate with an individual's sensitivity to propofol. METHODS A total of 54 subjects, including 30 patients and 24 healthy volunteers, were enrolled. Propofol was administered via a target-controlled infusion device, and anesthesia depth was monitored using a bispectral index monitor. Sensitivity to propofol was quantified using the induction time, measured from infusion onset to the bispectral index, which reached 60. Brain functional network metrics indicative of functional integration and segregation, centrality, and network resilience were computed from pre-anesthetic 60-channel EEG recordings. Linear regression analysis and machine learning predictive models were applied to evaluate the contribution of pre-anesthesia network metrics in predicting individual sensitivity to propofol. RESULTS Our analysis results revealed that subjects could be categorized into high- or low-sensitivity groups based on their induction time. Individuals with low sensitivity exhibited a greater network degree, clustering coefficient, global efficiency, and betweenness centrality, along with reduced modularity and assortativity coefficient in the alpha band. Furthermore, alpha band network metrics were significantly correlated with individual induction time. Leveraging these network metrics as features enabled the classification of individuals into high- or low-sensitivity groups with an accuracy of 94%. CONCLUSIONS Using a clinically relevant endpoint that signifies the level of anesthesia suitable for surgical procedures, this study underscored the robust correlation between pre-anesthesia alpha-band network metrics and individual sensitivity to propofol in a cohort that included both patients and healthy volunteers. Our findings offer preliminary insights into the potential utility of pre-anesthetic brain status assessment to predict propofol sensitivity on an individual basis, which may help to develop a more accurate personalized anesthesia plan.
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Affiliation(s)
- Yun Zhang
- School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China
| | - Fei Yan
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, PR China
| | - Yubo Wang
- School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China.
| | - Liyu Huang
- School of Life Science and Technology, Xidian University, Xi'an, 710126, PR China.
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Bellmann R, Weiler S. [Drug-drug interactions in critically ill patients]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01214-z. [PMID: 39607462 DOI: 10.1007/s00063-024-01214-z] [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: 03/04/2024] [Revised: 09/29/2024] [Accepted: 10/21/2024] [Indexed: 11/29/2024]
Abstract
Critically ill patients are at high risk of adverse drug-drug interactions. Pharmacodynamic drug-drug interaction may cause organ damage. Pharmacokinetic interactions are usually caused by inhibition or induction of enzymes of drug metabolism such as cytochrome P-450 isoenzymes or transporter proteins such as P‑glycoprotein. Inhibitors of such molecules can cause toxic levels of the corresponding substrates, while inducers might produce subtherapeutic concentrations. Amiodarone, macrolides, antifungal azoles, direct-acting anticoagulants, vitamin K antagonists, immunosuppressants, rifampicin, and some central nervous system (CNS)-active substances are frequently involved in drug-drug interactions. Sound risk and benefit assessment of the applied medication, therapeutic drug monitoring, the use of electronic alert systems and databases along with clinical evaluation will contribute to avoiding adverse drug-drug interactions.
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Affiliation(s)
- Romuald Bellmann
- Arbeitsgruppe Klinische Pharmakokinetik, Labor für Inflammationsforschung, Gemeinsame Einrichtung Internistische Notfall- und Intensivmedizin, Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Stefan Weiler
- Pharmakoepidemiologie, Institut für Pharmazeutische Wissenschaften, Eidgenössische Technische Hochschule (ETH) Zürich, Zürich, Schweiz
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Sleigh JW, Morgan PG. Are Genome-wide Association Studies Worth the Trouble? Anesthesiology 2024; 141:214-216. [PMID: 38980159 PMCID: PMC11239121 DOI: 10.1097/aln.0000000000005074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Affiliation(s)
- Jamie W Sleigh
- Department of Anaesthesiology, Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, NZ
| | - Philip G Morgan
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
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Li J, Zhang Z, Liu H, Qu X, Yin X, Chen L, Guo N, Wang C, Zhang Z. Effects of continuous intravenous infusion with propofol on intestinal metabolites in rats. Biomed Rep 2024; 20:25. [PMID: 38169795 PMCID: PMC10758916 DOI: 10.3892/br.2023.1713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/18/2023] [Indexed: 01/05/2024] Open
Abstract
Microbial metabolites play an important role in regulating intestinal homeostasis and immune responses. Propofol is a common anesthetic in clinic, but it is not clear whether it affects intestinal metabolites in rats. Tail vein puncture was performed after adaptive feeding for 1 month in eight 2-month-old rats and they were given continuous intravenous infusion of propofol for 3 h. The feces of rats were divided into different groups based on time periods, with before and after anesthesia with propofol on days 1, 3 and 7 labeled as groups P, A1, A3 and A7, respectively. The effect of continuous intravenous infusion with propofol on rat fecal metabolites was determined using the non-targeted metabolomics technique gas chromatography coupled with a time-of-flight mass spectrometer analysis. The types and contents of metabolites in rat feces were changed after continuous intravenous infusion with propofol, but the changes were not statistically significant. The contents of the metabolites 3-hydroxyphenylacetic acid and palmitic acid increased from day 3 to 7, and it was shown that the two metabolites were positively correlated at a statistically significant level. Linoleic acid decreased to its lowest level on day 3, and it returned to pre-anesthesia level on day 7. At the same time, linoleic acid metabolism was a metabolic pathway that was co-enriched 7 days after infusion with propofol. Spearman correlation analysis showed that there was significant correlation between some differential metabolites and differential microorganisms. It was observed that zymosterol 1, cytosin and elaidic acid were negatively correlated with Alloprevotella in the A3 vs. P group. In the A7 vs. P group, cortexolone 3 and coprostan-3-one were positively correlated with Faecalibacterium, whilst aconitic acid was negatively correlated with it. In conclusion, the present study revealed statistically insignificant effects of continuous intravenous propofol on the intestinal metabolites in rats.
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Affiliation(s)
- Jiaying Li
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Zhongjie Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Hongyu Liu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Xutong Qu
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Xueqing Yin
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Lu Chen
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Nana Guo
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
| | - Zhaodi Zhang
- Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P.R. China
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Klar P, Çatal Y, Langner R, Huang Z, Northoff G. Scale-free dynamics in the core-periphery topography and task alignment decline from conscious to unconscious states. Commun Biol 2023; 6:499. [PMID: 37161021 PMCID: PMC10170069 DOI: 10.1038/s42003-023-04879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/26/2023] [Indexed: 05/11/2023] Open
Abstract
Scale-free physiological processes are ubiquitous in the human organism. Resting-state functional MRI studies observed the loss of scale-free dynamics under anesthesia. In contrast, the modulation of scale-free dynamics during task-related activity remains an open question. We investigate scale-free dynamics in the cerebral cortex's unimodal periphery and transmodal core topography in rest and task states during three conscious levels (awake, sedation, and anesthesia) complemented by computational modelling (Stuart-Landau model). The empirical findings demonstrate that the loss of the brain's intrinsic scale-free dynamics in the core-periphery topography during anesthesia, where pink noise transforms into white noise, disrupts the brain's neuronal alignment with the task's temporal structure. The computational model shows that the stimuli's scale-free dynamics, namely pink noise distinguishes from brown and white noise, also modulate task-related activity. Together, we provide evidence for two mechanisms of consciousness, temporo-spatial nestedness and alignment, suggested by the Temporo-Spatial Theory of Consciousness (TTC).
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Affiliation(s)
- Philipp Klar
- Medical Faculty, C. & O. Vogt-Institute for Brain Research, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
| | - Yasir Çatal
- The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
| | - Robert Langner
- Institute of Systems Neuroscience, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany
| | - Zirui Huang
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
- Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - Georg Northoff
- The Royal's Institute of Mental Health Research & University of Ottawa. Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, ON, K1Z 7K4, Canada
- Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Hangzhou, Zhejiang Province, 310013, China
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Silva MAP, Figueiredo DBS, Lara JR, Paschoalinotte EE, Braz LG, Braz MG. Evaluation of genetic instability, oxidative stress, and metabolism-related gene polymorphisms in workers exposed to waste anesthetic gases. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:9609-9623. [PMID: 36057057 DOI: 10.1007/s11356-022-22765-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Professionals who work in operating rooms (ORs) may be exposed daily to waste anesthetic gases (WAGs) due to the use of inhalational anesthetics. Considering the controversial findings related to genetic damage and redox status in addition to a lack of knowledge about the effect of polymorphisms in genes related to phase I and II detoxification upon occupational exposure to WAGs, this cross-sectional study is the first to jointly evaluate biomarkers of genetic instability, oxidative stress, and susceptibility genes in professionals occupationally exposed to high trace amounts of halogenated (≥ 7 ppm) and nitrous oxide (165 ppm) anesthetics in ORs and in individuals not exposed to WAGs (control group). Elevated rates of buccal micronucleus (MN) and nuclear bud (NBUD) were observed in the exposure group and in professionals exposed aged more than 30 years. Exposed males showed a higher antioxidant capacity, as determined by the ferric reducing antioxidant power (FRAP), than exposed females; exposed females had higher frequencies of MN and NBUD than nonexposed females. Genetic instability (MN) was observed in professionals with greater weekly WAG exposure, and those exposed for longer durations (years) exhibited oxidative stress (increased lipid peroxidation and decreased FRAP). Polymorphisms in metabolic genes (cytochrome P450 2E1 (CYP2E1) and glutathione S-transferases (GSTs)) did not exert an effect, except for the effects of the GSTP1 (rs1695) AG/GG polymorphism on FRAP (both groups) and GSTP1 AG/GG and GSTT1 null polymorphisms, which were associated with greater FRAP values in exposed males. Minimizing WAG exposure is necessary to reduce impacts on healthcare workers.
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Affiliation(s)
- Mariane A P Silva
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Drielle B S Figueiredo
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Juliana R Lara
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Eloisa E Paschoalinotte
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Leandro G Braz
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Mariana G Braz
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil.
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