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Braz MG, Silva MAP, Scorza CE, Lara JR, Braz JRC, Braz LG. Comparison between inhalational anesthetics in terms of DNA damage and immunological markers. Environ Mol Mutagen 2024. [PMID: 38679908 DOI: 10.1002/em.22600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/01/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
This study compared genetic damage and immunological markers between surgical patients who underwent inhalational anesthesia with isoflurane or sevoflurane. Blood samples were collected from surgical patients (n = 18 in the isoflurane group and n = 17 in the sevoflurane group) at baseline (before the anesthesia procedure) and the day after anesthesia. DNA damage was detected using an alkaline comet assay; proinflammatory interleukin (IL)-6 was detected by flow cytometry, and white blood cells were detected via an automatic hematology analyzer. The characteristics of both groups were similar, and neither of the two anesthetics induced DNA damage. Similarly, mild neutrophilia was observed after anesthesia in both groups. Increased IL-6 levels were observed 1 day after anesthesia regardless of the type of anesthetic, but this increase was greater in the isoflurane group. Our study suggested that isoflurane and sevoflurane administration may contribute to changes in the immune parameters measured, though no genotoxic hazard was identified, in healthy adult patients who undergo low-stress surgery.
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Affiliation(s)
- Mariana G Braz
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Brazil
| | - Mariane A P Silva
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Brazil
| | - Carlos E Scorza
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Brazil
| | - Juliana R Lara
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Brazil
| | | | - Leandro G Braz
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Brazil
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Silva MAP, Braz LG, Braz JRC, Braz MG. Modulation of gene expression and inflammation but not DNA damage after sevoflurane anesthesia. Environ Mol Mutagen 2023. [PMID: 37000683 DOI: 10.1002/em.22539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
This study assessed, for the first time, the expression of the genes hOGG1, TP53, and IL-6 in leukocytes by real-time quantitative polymerase chain reaction in surgical patients before (baseline), during (2 h of anesthesia) and 1 day after sevoflurane anesthesia. Additionally, DNA damage was detected by the comet assay, serum interleukin (IL)-6 was detected by flow cytometry, and differential leukocyte counting was also performed. TP53 and hOGG1 expression was downregulated on the day after anesthesia compared to before anesthesia. However, IL-6 expression did not change, and no DNA damage induction was observed during or after anesthesia. At the systemic level, mild neutrophilia and an increase in IL-6 levels occurred after anesthesia. Our findings suggest that sevoflurane anesthesia downregulates gene expression (hOGG1 and TP53) and contributes to an inflammatory status (increased systemic IL-6 and mild neutrophilia) but is not associated with DNA damage in patients without comorbidities who undergo minor elective surgery.
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Affiliation(s)
- Mariane A P Silva
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - José Reinaldo C Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, São Paulo, Brazil
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Braz LG, Braz MG, Tiradentes TAA, Braz JRC. A correlation between anaesthesia-related cardiac arrest outcomes and country human development index: A narrative review. J Clin Anesth 2021; 72:110273. [PMID: 33957413 DOI: 10.1016/j.jclinane.2021.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Studies have demonstrated gaps between developed and developing countries in the quality of surgical and anaesthesia care. The aim of this review was to provide a critical overview of documented outcomes from the 2010s of anaesthesia-related cardiac arrest events in countries with largely differing Human Development Indexes (HDIs). The HDI ranges from 0 to 1, representing the lowest and highest levels of development, respectively. Most related studies conducted between 2011 and 2020 showed low rates (from 0 to 215 per million anaesthetics) of anaesthesia-related mortality up to the 30th postoperative day in very high-HDI countries (HDI ≥ 0.800) and higher rates (from 0 to 915.4 per million anaesthetics) in high-HDI countries (HDI: 0.700-0.799). Low-HDI countries (HDI < 0.550) showed higher anaesthesia-related mortality rates, which were greater than 1500 per million anaesthetics. The anaesthesia-related mortality rates per quartile demonstrated a gap in the anaesthesia-related safety between very high- and high-HDI countries, and especially between very high- and low-HDI countries. Anaesthesia-related cardiac arrest showed similarly high survival proportions in very high-HDI countries (45.9% to 100%) and high-HDI countries (62.9% to 100%), while in a low-HDI country, the anaesthesia-related cardiac arrest survival was lower (22.2%). Our review demonstrates large gaps among countries with largely differing HDIs regarding anaesthesia-related cardiac arrest outcomes in the last decade. This finding highlights the need to improve patient safety care in low-HDI countries. Anaesthesia patient safety has improved in high-HDI countries, but there is still a persistent gap in the health care systems of these countries and those of very high-HDI countries. Our review also found a consistent improvement in anaesthesia patient safety in very high-HDI countries.
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Affiliation(s)
- Leandro G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil.
| | - Mariana G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Teófilo Augusto A Tiradentes
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
| | - José Reinaldo C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, SP, Brazil
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Souza KM, De Vivo I, Chen CY, Nogueira FR, Aun AG, Arruda NM, Lara JR, Silva MAP, Figueiredo DBS, Corrêa CR, de Carvalho LR, Braz JRC, Braz LG, Braz MG. Oxidative stress, DNA damage, inflammation and gene expression in occupationally exposed university hospital anesthesia providers. Environ Mol Mutagen 2021; 62:155-164. [PMID: 33341964 DOI: 10.1002/em.22420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.
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Affiliation(s)
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Chung-Yen Chen
- Antioxidants Research Laboratory, Jean Mayer Human Nutrition Research Center on Aging (HNRCA), Tufts University, Boston, Massachusetts, USA
| | | | - Aline Garcia Aun
- Medical School, São Paulo State University (UNESP), Botucatu, Brazil
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Braz LG, Einav S, Heesen MA, Betini M, Corrente JE, Pacchioni M, Cury JB, Braz MG, Braz JRC. Association between intra-operative cardiac arrest and country Human Development Index status: a systematic review with meta-regression analysis and meta-analysis of observational studies . Anaesthesia 2021; 76:1259-1273. [PMID: 33512708 DOI: 10.1111/anae.15374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/07/2023]
Abstract
Intra-operative cardiac arrests differ from most in-hospital cardiac arrests because they reflect not only the patient's condition but also the quality of surgery and anaesthesia care provided. We assessed the relationship between intra-operative cardiac arrest rates and country Human Development Index (HDI), and the changes occurring in these rates over time. We searched PubMed, EMBASE, Scopus, LILACS, Web of Science, CINAHL and SciELO from inception to 29 January 2020. For the global population, rates of intra-operative cardiac arrest and baseline ASA physical status were extracted. Intra-operative cardiac arrest rates were analysed by time, country HDI status and ASA physical status using meta-regression analysis. Proportional meta-analysis was performed to compare intra-operative cardiac arrest rates and ASA physical status in low- vs. high-HDI countries and in two time periods. Eighty-two studies from 25 countries with more than 29 million anaesthetic procedures were included. Intra-operative cardiac arrest rates were inversely correlated with country HDI (p = 0.0001); they decreased over time only in high-HDI countries (p = 0.040) and increased with increasing ASA physical status (p < 0.0001). Baseline ASA physical status did not change in high-HDI countries (p = 0.106), while it decreased over time in low-HDI countries (p = 0.040). In high-HDI countries, intra-operative cardiac arrest rates (per 10,000 anaesthetic procedures) decreased from 9.59 (95%CI 6.59-13.16) pre-1990 to 5.17 (95%CI 4.42-5.97) in 1990-2020 (p = 0.013). During the same time periods, no improvement was observed in the intra-operative cardiac arrest rates in low-HDI countries (p = 0.498). Odds ratios of intra-operative cardiac arrest rates in ASA 3-5 patients were 8.48 (95%CI 1.67-42.99) times higher in low-HDI countries than in high-HDI countries (p = 0.0098). Intra-operative cardiac arrest rates are related to country-HDI and decreased over time only in high-HDI countries. The widening gap in these rates between low- and high-HDI countries needs to be addressed globally.
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Affiliation(s)
- L G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - S Einav
- Shaare Zedek Medical Centre, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M A Heesen
- Department of Anaesthesia, Kantonsspital Baden, Baden, Switzerland
| | - M Betini
- Technical Division of Library and Documentation, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - J E Corrente
- Department of Biostatistics, Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - M Pacchioni
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - J B Cury
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - M G Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - J R C Braz
- Anaesthesia Cardiac Arrest and Mortality Study Commission, Department of Surgical Specialties and Anaesthesiology, Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
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Arruda NM, Braz LG, Nogueira FR, Souza KM, Aun AG, de Carvalho LR, Braz JRC, Braz MG. Gene and systemic inflammatory effects and neuroendocrine response in surgical patients anesthetized with desflurane-nitrous oxide or desflurane-nitrous oxide-free: A randomized trial. Int Immunopharmacol 2020; 90:107163. [PMID: 33214094 DOI: 10.1016/j.intimp.2020.107163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/26/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
There is growing interest in assessing possible immunotoxicological effects in anesthetized patients. There are controversial findings concerning the effect of nitrous oxide (N2O) anesthetic gas effect on inflammatory response. We tested the hypothesis that N2O associated with desflurane (inhalational anesthetic) was likely to worsen neuro-immune-endocrine effects when compared with desflurane alone in this randomized trial. The primary endpoint of this study was to evaluate the systemic proinflammatory interleukin (IL)-6, and the secondary endpoints included other systemic (IL-1β, TNF-α, IL-8, IL-10, IL-17A and high-sensitivity C-reactive protein - hs-CRP) and genetic inflammatory markers (NF-kB, IL-6 and COX-2) as well as hormones (adrenocorticotropic hormone, cortisol and prolactin) comparing patients undergoing minor surgery with or without N2O-desflurane. As a second aim, we assessed whether there were changes in the neuro-immune-endocrine profiles within each group. Blood samples were collected before anesthesia, 90 min after anesthesia induction, and the day after surgery. We assessed serum cytokines using a cytometric bead array and hs-CRP by chemiluminescent immunoassay. Expression of three proinflammatory transcripts was assessed by real-time quantitative polymerase chain reaction, and neuroendocrine hormones were detected by chemiluminescent microparticle immunoenzymatic assay. There were no significant between-group differences for any analyzed biomarkers. However, there was a significant increase in: (a) systemic IL-6 and hs-CRP values one day after surgery in both groups and (b) prolactin levels in the intraoperative period compared to baseline and postoperative period levels for both groups. In conclusion, N2O does not impair the inflammatory profile and neuroendocrine response compared to patients who receive only desflurane anesthesia.
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Affiliation(s)
- Nayara M Arruda
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Flávia R Nogueira
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Kátina M Souza
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Aline G Aun
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Department of Biostatistics, Institute of Biosciences, São Paulo State University - UNESP, Botucatu, Brazil
| | - José Reinaldo C Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil.
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Braz MG, Carvalho LIM, Chen CYO, Blumberg JB, Souza KM, Arruda NM, Filho DAA, Resende LO, Faria RTBG, Canário CD, de Carvalho LR, Corrêa CR, Braz JRC, Braz LG. High concentrations of waste anesthetic gases induce genetic damage and inflammation in physicians exposed for three years: A cross-sectional study. Indoor Air 2020; 30:512-520. [PMID: 31930534 DOI: 10.1111/ina.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
This cross-sectional study analyzed the impact of occupational waste anesthetic gases on genetic material, oxidative stress, and inflammation status in young physicians exposed to inhalational anesthetics at the end of their medical residency. Concentrations of waste anesthetic gases were measured in the operating rooms to assess anesthetic pollution. The exposed group comprised individuals occupationally exposed to inhalational anesthetics, while the control group comprised individuals without anesthetic exposure. We quantified DNA damage; genetic instability (micronucleus-MN); protein, lipid, and DNA oxidation; antioxidant activities; and proinflammatory cytokine levels. Trace concentrations of anesthetics (isoflurane: 5.3 ± 2.5 ppm, sevoflurane: 9.7 ± 5.9 ppm, and nitrous oxide: 180 ± 150 ppm) were above international recommended thresholds. Basal DNA damage and IL-17A were significantly higher in the exposed group [27 ± 20 a.u. and 20.7(19.1;31.8) pg/mL, respectively] compared to the control group [17 ± 11 a.u. and 19.0(18.9;19.5) pg/mL, respectively], and MN frequency was slightly increased in the exposed physicians (2.3-fold). No significant difference was observed regarding oxidative stress biomarkers. The findings highlight the genetic and inflammatory risks in young physicians exposed to inhalational agents in operating rooms lacking adequate scavenging systems. This potential health hazard can accompany these subjects throughout their professional lives and reinforces the need to reduce ambient air pollution and consequently, occupational exposure.
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Affiliation(s)
- Mariana G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Lorena I M Carvalho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Chung-Yen O Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Jeffrey B Blumberg
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Kátina M Souza
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Nayara M Arruda
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Daniel A A Filho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Ludimila O Resende
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Renata T B G Faria
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Clara d'A Canário
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Department of Bioestatistics, Institute of Biosciences, São Paulo State University - UNESP, Botucatu, Brazil
| | - Camila R Corrêa
- Department of Pathology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - José Reinaldo C Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
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Braz LG, Carlucci MTO, Braz JRC, Módolo NSP, do Nascimento P, Braz MG. Perioperative cardiac arrest and mortality in trauma patients: A systematic review of observational studies. J Clin Anesth 2020; 64:109813. [PMID: 32304957 DOI: 10.1016/j.jclinane.2020.109813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/18/2020] [Accepted: 04/04/2020] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE Factors that influence the occurrence of perioperative cardiac arrest (CA) and its outcomes in trauma patients are not well known. The novelty of our study lies in the performance of a systematic review conducted worldwide on the occurrence of perioperative CA and/or mortality in trauma patients. DESIGN A systematic review was performed to identify observational studies that reported the occurrence of CA and/or mortality due to trauma and CA and/or mortality rates in trauma patients up to 24 h postoperatively. We searched the MEDLINE, EMBASE, LILACS and SciELO databases through January 29, 2020. SETTING Perioperative period. MEASUREMENTS The primary outcomes evaluated were data on the epidemiology of perioperative CA and/or mortality in trauma patients. MAIN RESULTS Nine studies were selected, with the first study being published in 1994 and the most recent being published in 2019. Trauma was an important factor in perioperative CA and mortality, with rates of 168 and 74 per 10,000 anesthetic procedures, respectively. The studies reported a higher proportion of perioperative CA and mortality in trauma patients who were males, young adults and adults, patients with American Society of Anesthesiologists (ASA) physical status ≥ III, patients undergoing general anesthesia, and in abdominal or neurological surgeries. Uncontrolled hemorrhage was the main cause of perioperative CA and mortality after trauma. Survival rates after perioperative CA were low. CONCLUSIONS Trauma is an important factor in perioperative CA and mortality, especially in young adult and adult males and in patients classified as having an ASA physical status ≥ III mainly due to uncontrollable bleeding after blunt and perforating injuries. Trauma is a global public health problem and has a strong impact on perioperative morbidity and mortality.
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Affiliation(s)
- Leandro G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil.
| | - Marcelo T O Carlucci
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil
| | - José Reinaldo C Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil
| | - Norma S P Módolo
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil
| | - Paulo do Nascimento
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil
| | - Mariana G Braz
- Anesthesia Cardiac Arrest and Mortality Study Commission, Sao Paulo State University - UNESP, Botucatu Medical School, Department of Anesthesiology, Brazil
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Arruda NM, Braz LG, Nogueira FR, Souza KM, Aun AG, Figueiredo DB, Lara JR, Silva MAP, Golim MA, de Carvalho LR, Braz JRC, Braz MG. Inflammation and DNA damage induction in surgical patients maintained with desflurane anesthesia. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 2019; 846:403073. [DOI: 10.1016/j.mrgentox.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 01/20/2023]
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Aun AG, Golim MA, Nogueira FR, Souza KM, Arruda NM, Braz JRC, Braz LG, Braz MG. Monitoring early cell damage in physicians who are occupationally exposed to inhalational anesthetics. Mutat Res 2018; 812:5-9. [PMID: 30388507 DOI: 10.1016/j.mrfmmm.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
Worldwide, millions of professionals who work in operating rooms are occupationally exposed to inhalational anesthetics. Thus, the potential health effects of the continuous exposure to inhalational anesthetics on individuals in the operating room remain a subject of debate. Human biomonitoring is a potentially useful tool for assessing the health of exposed professionals. No report has yet evaluated the possible cytotoxic and genotoxic effects of the most commonly used inhalational anesthetics on young professionals who are occupationally exposed. Considering the importance of this issue, we monitored physicians who were exposed to inhalational anesthetics during their first year of a medical residency program to evaluate the possible early damage events. Twenty-six young physicians who had been occupationally exposed to the anesthetics isoflurane, sevoflurane, desflurane, and nitrous oxide and who worked in operating rooms using modern anesthesia workstations during their medical residency program, participated in this study. Blood samples were evaluated before the start of the program (before the exposure), and after 1/2 year and 1 year of exposure. We monitored the subjects by assessing the cytotoxicity (early apoptosis and loss of the mitochondrial membrane potential) using flow cytometry and genotoxicity using the comet assay. No significant changes were observed in the biomarkers of cytotoxicity or genotoxicity (p > 0.05). Thus, biomonitoring showed that short-term exposure to inhalational anesthetics did not induce early cell damage during the first year of medical residency. Based on the results, brief occupational exposure to anesthetics does not induce either cytotoxicity or genotoxicity in mononuclear cells under the conditions of this study. Thus, young physicians should undergo additional biomonitoring at the beginning of their careers to determine possible toxic effects on their cells and genetic material, and further investigations are warranted to determine whether a longer exposure to inhalational anesthetics results in mitochondrial depolarization, apoptosis and DNA breaks.
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Affiliation(s)
- Aline G Aun
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Marjorie A Golim
- UNESP - Universidade Estadual Paulista, Hospital das Clínicas de Botucatu, Hemocentro, Laboratório de Citometria de Fluxo, Brazil
| | - Flávia R Nogueira
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Kátina M Souza
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Nayara M Arruda
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - José Reinaldo C Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Leandro G Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Mariana G Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil.
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Braz MG, Souza KM, Lucio LMC, Di Renzo GCC, Feliciano LM, Marcondes JPC, Chen CYO, Braz JRC, Braz LG. Detrimental effects detected in exfoliated buccal cells from anesthesiology medical residents occupationally exposed to inhalation anesthetics: An observational study. Mutat Res Genet Toxicol Environ Mutagen 2018; 832-833:61-64. [PMID: 30057022 DOI: 10.1016/j.mrgentox.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
Operating room professionals are scarcely aware of their individual occupational exposure to waste anesthetic gases (WAGs). Medical residents spend several hours per day in operating rooms and consequently experience occupational exposure to WAGs. Considering that no studies have yet evaluated the potential toxicity in medical residents exposed to WAGs using the buccal micronucleus cytome (BMCyt) assay, this pioneering study aimed to compare the BMCyt assay markers, including DNA damage, cell proliferation, and cell death in the exfoliated buccal cells of surgery and anesthesiology residents occupationally exposed to WAGs. The study enrolled a total of 60 physicians, including internal medicine residents (unexposed group), and residents from surgery and anesthesiology programs who were occupationally exposed to sevoflurane, isoflurane and nitrous oxide. WAGs were measured, and the mean values were higher than the international recommendation. The anesthesiology residents (high exposure) showed statistically significant lower frequencies of basal cells, and statistically significant higher frequencies of micronuclei, karyorrhexis, pyknosis, and differentiated cells than did the unexposed group; karyolysis frequencies were significantly higher in anesthesiology residents than were those in the unexposed group or in surgical residents (low exposure). The findings suggest a genetic risk for young professionals exposed to WAGs at the beginning of their careers. Thus, exposure to high WAGs concentrations leads to impairment of the buccal cell proliferative potential, genomic instability and cell death, especially in anesthesiology residents, demonstrating an early impact on their health.
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Affiliation(s)
- Mariana G Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil.
| | - Kátina M Souza
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Lorena M C Lucio
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Giulia C C Di Renzo
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Luciana M Feliciano
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Instituto de Biociências, Departamento de Genética, Botucatu, SP, Brazil
| | - João Paulo C Marcondes
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Instituto de Biociências, Departamento de Genética, Botucatu, SP, Brazil
| | - C-Y Oliver Chen
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - José Reinaldo C Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leandro G Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
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Nogueira FR, Braz LG, Souza KM, Aun AG, Arruda NM, Carvalho LR, Chen CYO, Braz JRC, Braz MG. Comparison of DNA Damage and Oxidative Stress in Patients Anesthetized With Desflurane Associated or Not With Nitrous Oxide. Anesth Analg 2018; 126:1198-1205. [DOI: 10.1213/ane.0000000000002729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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13
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Freire CMM, Braz MG, Marcondes JPC, Arruda NM, Braz JRC, Rainho CA, Braz LG, Salvadori DMF. Expression and promoter methylation status of two DNA repair genes in leukocytes from patients undergoing propofol or isoflurane anaesthesia. Mutagenesis 2018; 33:147-152. [DOI: 10.1093/mutage/gey001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Cristiana M M Freire
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Mariana G Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - João Paulo C Marcondes
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
| | - Nayara M Arruda
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - José Reinaldo C Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Cláudia A Rainho
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
| | - Leandro G Braz
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
| | - Daisy M F Salvadori
- UNESP – São Paulo State University, Medical School, Professor Mário Rubens G. Montenegro Av., Botucatu - SP, Brazil
- UNESP – São Paulo State University, Institute of Biosciences, Prof. Dr. Antonio Celso Wagner Zanin St., Botucatu - SP, Brazil
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Lucio LM, Braz MG, Nascimento Junior PD, Braz JRC, Braz LG. Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases. Braz J Anesthesiol 2018. [PMID: 28655457 PMCID: PMC9391701 DOI: 10.1016/j.bjane.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and objectives The waste anesthetic gases (WAGs) present in the ambient air of operating rooms (OR), are associated with various occupational hazards. This paper intends to discuss occupational exposure to WAGs and its impact on exposed professionals, with emphasis on genetic damage and oxidative stress. Content Despite the emergence of safer inhaled anesthetics, occupational exposure to WAGs remains a current concern. Factors related to anesthetic techniques and anesthesia workstations, in addition to the absence of a scavenging system in the OR, contribute to anesthetic pollution. In order to minimize the health risks of exposed professionals, several countries have recommended legislation with maximum exposure limits. However, developing countries still require measurement of WAGs and regulation for occupational exposure to WAGs. WAGs are capable of inducing damage to the genetic material, such as DNA damage assessed using the comet assay and increased frequency of micronucleus in professionals with long-term exposure. Oxidative stress is also associated with WAGs exposure, as it induces lipid peroxidation, oxidative damage in DNA, and impairment of the antioxidant defense system in exposed professionals. Conclusions The occupational hazards related to WAGs including genotoxicity, mutagenicity and oxidative stress, stand as a public health issue and must be acknowledged by exposed personnel and responsible authorities, especially in developing countries. Thus, it is urgent to stablish maximum safe limits of concentration of WAGs in ORs and educational practices and protocols for exposed professionals.
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de Oliveira SAR, Lucio LMC, Modolo NSP, Hayashi Y, Braz MG, de Carvalho LR, Braz LG, Braz JRC. The Humidity in a Low-Flow Dräger Fabius Anesthesia Workstation with or without Thermal Insulation or a Heat and Moisture Exchanger: A Prospective Randomized Clinical Trial. PLoS One 2017; 12:e0170723. [PMID: 28129353 PMCID: PMC5271343 DOI: 10.1371/journal.pone.0170723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 12/31/2016] [Indexed: 11/18/2022] Open
Abstract
Background During anesthesia, as compared with intensive care, the time of the tracheal intubation is much shorter. An inhaled gas minimum humidity of 20 mgH2O.L-1 is recommended to reduce the deleterious effects of dry gas on the airways during anesthesia with tracheal intubation. The Fabius GS Premium® anesthesia workstation (Dräger Medical, Lübeck, Germany) has a built-in hotplate to heat gases in the breathing circuit. A heat and moisture exchanger (HME) is used to further heat and humidify the inhaled gas. The humidity of the gases in the breathing circuit is influenced by the ambient temperature. We compared the humidity of the inhaled gases from a low-flow Fabius anesthesia workstation with or without thermal insulation (TI) of the breathing circuit and with or without an HME. Methods We conducted a prospective randomized trial in 41 adult female patients who underwent elective abdominal surgery. The patients were allocated into four groups according to the devices used to ventilate their lungs using a Dräger Fabius anesthesia workstation with a low gas flow (1 L.min-1): control, with TI, with an HME or with TI and an HME (TIHME). The mean temperature and humidity of the inhaled gases were measured during 2-h after connecting the patients to the breathing circuit. Results The mean inhaled gas temperature and absolute humidity were higher in the HME (29.2±1.3°C; 28.1±2.3 mgH2O·L-1) and TIHME (30.1±1.2°C; 29.4±2.0 mgH2O·L-1) groups compared with the control (27.5±1.0°C; 25.0±1.8 mgH2O·L-1) and TI (27.2±1.1°C; 24.9±1.8 mgH2O·L-1) groups (P = 0.003 and P<0.001, respectively). Conclusions The low-flow Fabius GS Premium breathing circuit provides the minimum humidity level of inhaled gases to avoid damage to the tracheobronchial epithelia during anesthesia. TI of the breathing circuit does not increase the humidity of the inhaled gases, whereas inserting an HME increases the moisture of the inhaled gases closer to physiological values.
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Affiliation(s)
- Sergius A. R. de Oliveira
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Lorena M. C. Lucio
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Norma S. P. Modolo
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Yoko Hayashi
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Mariana G. Braz
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Lídia R. de Carvalho
- Department of Biostatistics, Institute of Biosciences, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - Leandro G. Braz
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
| | - José Reinaldo C. Braz
- Department of Anesthesiology, Botucatu Medical School, UNESP–Univ Estadual Paulista, Botucatu, Sao Paulo State, Brazil
- * E-mail:
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Souza KM, Braz LG, Nogueira FR, Souza MB, Bincoleto LF, Aun AG, Corrente JE, Carvalho LR, Braz JRC, Braz MG. Occupational exposure to anesthetics leads to genomic instability, cytotoxicity and proliferative changes. Mutat Res 2016; 791-792:42-48. [PMID: 27639372 DOI: 10.1016/j.mrfmmm.2016.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/28/2022]
Abstract
Data on the genotoxic and mutagenic effects of occupational exposure to the most frequently used volatile anesthetics are limited and controversial. The current study is the first to evaluate genomic instability, cell death and proliferative index in exfoliated buccal cells (EBC) from anesthesiologists. We also evaluated DNA damage and determined the concentrations of the anesthetic gases most commonly used in operating rooms. This study was conducted on physicians who were allocated into two groups: the exposed group, which consisted of anesthesiologists who had been exposed to waste anesthetic gases (isoflurane, sevoflurane, desflurane and nitrous oxide - N2O) for at least two years; and the control group, which consisted of non-exposed physicians matched for age, sex and lifestyle with the exposed group. Venous blood and EBC samples were collected from all participants. Basal DNA damage was evaluated in lymphocytes by the comet assay, whereas the buccal micronucleus (MN) cytome (BMCyt) assay was applied to evaluate genotoxic and cytotoxic effects. The concentrations of N2O and anesthetics were measured via a portable infrared spectrophotometer. The average concentration of waste gases was greater than 5 parts per million (ppm) for all of the halogenated anesthetics and was more than 170ppm for N2O, expressed as a time-weighted average. There was no significant difference between the groups in relation to lymphocyte DNA damage. The exposed group had higher frequencies of MN, karyorrhexis and pyknosis, and a lower frequency of basal cells compared with the control group. In conclusion, exposure to modern waste anesthetic gases did not induce systemic DNA damage, but it did result in genomic instability, cytotoxicity and proliferative changes, which were detected in the EBC of anesthesiologists. Thus, these professionals can be considered at risk for developing genetic alterations resulting from occupational exposure to these gases, suggesting the need to minimize this exposure.
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Affiliation(s)
- Kátina M Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Leandro G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Flávia R Nogueira
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Marajane B Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Lahis F Bincoleto
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Aline G Aun
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - José E Corrente
- Instituto de Biociências de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Bioestatística, Botucatu, Brazil
| | - Lídia R Carvalho
- Instituto de Biociências de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Bioestatística, Botucatu, Brazil
| | - José Reinaldo C Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Mariana G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil.
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Nogueira FR, Braz LG, de Andrade LR, de Carvalho ALR, Vane LA, Módolo NSP, Aun AG, Souza KM, Braz JRC, Braz MG. Evaluation of genotoxicity of general anesthesia maintained with desflurane in patients under minor surgery. Environ Mol Mutagen 2016; 57:312-316. [PMID: 27062561 DOI: 10.1002/em.22012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
There is controversy over the genotoxic effects of volatile anesthetics. The available literature on the genotoxicity of desflurane, one of the newest volatile halogenated agents used for general anesthesia maintenance, is scarce. This study aimed to evaluate the genotoxic potential of desflurane in 15 patients without comorbidities, of both sexes, who underwent minor surgeries lasting at least 90 min. Patients enrolled in the study received desflurane anesthesia (6%); blood samples were collected before anesthesia induction (T0), 90 min after the beginning of anesthesia (T1), and on the day following surgery (T2). DNA damage was evaluated in lymphocytes using the alkaline comet assay. We found statistically significant increases in DNA damage in T2 samples compared to T0. The findings suggest that desflurane anesthesia induces DNA strand breaks/alkali-labile sites on the day after minimally invasive surgery in healthy patients.
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Affiliation(s)
- Flávia R Nogueira
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leandro G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leonardo R de Andrade
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Ana Lygia R de Carvalho
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Luiz A Vane
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Norma Sueli P Módolo
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Aline G Aun
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Kátina M Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - José Reinaldo C Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Mariana G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
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Pignaton W, Braz JRC, Kusano PS, Módolo MP, de Carvalho LR, Braz MG, Braz LG. Perioperative and Anesthesia-Related Mortality: An 8-Year Observational Survey From a Tertiary Teaching Hospital. Medicine (Baltimore) 2016; 95:e2208. [PMID: 26765400 PMCID: PMC4718226 DOI: 10.1097/md.0000000000002208] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In 2006, a previous study at our institution reported high perioperative and anesthesia-related mortality rates of 21.97 and 1.12 per 10,000 anesthetics, respectively. Since then, changes in surgical practices may have decreased these rates. However, the actual perioperative and anesthesia-related mortality rates in Brazil remains unknown. The study aimed to reexamine perioperative and anesthesia-related mortality rates in one Brazilian tertiary teaching hospital.In this observational study, deaths occurring in the operation room and postanesthesia care unit between April 2005 and December 2012 were identified from an anesthesia database. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA) physical status, and medical specialty teams, as well as the types of surgery and anesthesia. All deaths were reviewed and grouped by into 1 of 4 triggering factors groups: totally anesthesia-related, partially anesthesia-related, surgery-related, or disease/condition-related. The mortality rates are expressed per 10,000 anesthetics with 95% confidence intervals (CIs).A total of 55,002 anesthetics and 88 deaths were reviewed, representing an overall mortality rate of 16.0 per 10,000 anesthetics (95% CI: 13.0-19.7). There were no anesthesia-related deaths. The major causes of mortality were patient disease/condition-related (13.8, 95% CI: 10.7-16.9) followed by surgery-related (2.2, 95% CI: 1.0-3.4). The major risks of perioperative mortality were children younger than 1-year-old, older patients, patients with poor ASA physical status (III-V), emergency, cardiac or vascular surgeries, and multiple surgeries performed under the same anesthetic technique (P < 0.0001).There were no anesthesia-related deaths. However, the high mortality rate caused by the poor physical conditions of some patients suggests that primary prevention might be the key to reducing perioperative mortality. These findings demonstrate the need to improve medical perioperative practices for high-risk patients in under-resourced settings.
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Affiliation(s)
- Wangles Pignaton
- From the Anesthesia Cardiac Arrest and Mortality Study Commission, Department of Anesthesiology, Botucatu Medical School (WP, JRCB, PSK, MPM, MGB, LGB); and Department of Biostatistics, Institute of Biosciences, UNESP, University Estadual Paulista, Botucatu, Brazil (LRDC)
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Orosz JEB, Braz LG, Ferreira ALA, Amorim RB, Salvadori DMF, Yeum KJ, Braz JRC, Braz MG. Balanced anesthesia with sevoflurane does not alter redox status in patients undergoing surgical procedures. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 2014; 773:29-33. [DOI: 10.1016/j.mrgentox.2014.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
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Braz MG, Orosz JEB, Pierine DT, Braz LG, Ferreira ALA, Salvadori DMF, Yeum K, Braz JRC. Evaluation of Oxidative DNA Damage, Lipid Peroxidation and Antioxidant Status in Patients Undergoing Surgery with Sevoflurane Anesthesia. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.974.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Braz LG, Módolo NSP, do Nascimento P, Bruschi BAM, Castiglia YMM, Ganem EM, de Carvalho LR, Braz JRC. Perioperative cardiac arrest: a study of 53 718 anaesthetics over 9 yr from a Brazilian teaching hospital. Br J Anaesth 2006; 96:569-75. [PMID: 16565228 DOI: 10.1093/bja/ael065] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little information exists regarding factors influencing perioperative cardiac arrests and their outcome. This survey evaluated the incidence, causes and outcome of perioperative cardiac arrests in a Brazilian tertiary general teaching hospital between April 1996 and March 2005. METHODS The incidence of cardiac arrest during anaesthesia was prospectively identified from an anaesthesia database. There were 53,718 anaesthetics during the study period. Data collected included patient characteristics, surgical procedures (elective, urgent or emergency), ASA physical status classification, anaesthesia provider information, type of surgery, surgical areas and outcome. All cardiac arrests were retrospectively reviewed and grouped by cause of arrest and death into one of four groups: totally anaesthesia related, partially anaesthesia related, totally surgery related or totally patient disease or condition related. RESULTS One hundred and eighty-six cardiac arrests (34.6:10,000) and 118 deaths (21.97:10,000) were found. Major risk factors for cardiac arrest were neonates, children under 1 yr and the elderly (P<0.05), male patients with ASA III or poorer physical status (P<0.05), in emergency surgery (P<0.05) and under general anaesthesia (P<0.05). Patient disease/condition was the major cause of cardiac arrest or death (P<0.05). There were 18 anaesthesia-related cardiac arrests (3.35:10,000) -- 10 totally attributed (1.86:10,000) and 8 partially related to anaesthesia (1.49:10,000). There were 6 anaesthesia-related deaths (1.12:10,000) -- 3 totally attributable and 3 partially related to anaesthesia (0.56:10,000 in both cases). The main causes of anaesthesia-related cardiac arrest were respiratory events (55.5%) and medication-related events (44.5%). CONCLUSIONS Perioperative cardiac arrests were relatively higher in neonates, infants, the elderly and in males with severe underlying disease and under emergency surgery. All anaesthesia-related cardiac arrests were related to airway management and medication administration which is important for prevention strategies.
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Affiliation(s)
- L G Braz
- Department of Anaesthesiology, Institute of Bioscience, School of Medicine, UNESP, São Paulo State University Botucatu, São Paulo State, Brazil
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Cruz ML, Sacchi T, Luna SPL, Braz JRC, Cassu RN. Use of a laryngeal mask for airway maintenance during inhalation anaesthesia in rabbits. Vet Anaesth Analg 2000; 27:115-116. [DOI: 10.1046/j.1467-2995.2000.00018-5.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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