Anesthetics In Surgery Research Articles

Propofol inhibits lung cancer cell viability and induces cell apoptosis by upregulating microRNA-486 expression

Propofol is a frequently used intravenous anesthetic agent. Recent studies show that propofol exerts a number of non-anesthetic effects. The present study aimed to investigate the effects of propofol on lung cancer cell lines H1299 and H1792 and functional role of microRNA (miR)-486 in these effects. H1299 and/or H1792 cells were treated with or without propofol and transfected or not with miR-486 inhibitor, and then cell viability and apoptosis were analyzed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and flow cytometry. The expression of miR-486 was determined by quantitative real-time polymerase chain reaction (qRT-PCR) with or without propofol treatment. Western blot was performed to analyze the protein expression of Forkhead box, class O (FOXO) 1 and 3, Bcl-2 interacting mediator of cell death (Bim), and pro- and activated caspases-3. Results showed that propofol significantly increased the miR-486 levels in both H1299 and H1792 cells compared to untreated cells in a dose-dependent manner (P<0.05 or P<0.01). Propofol statistically decreased cell viability but increased the percentages of apoptotic cells and protein expressions of FOXO1, FOXO3, Bim, and pro- and activated caspases-3; however, miR-486 inhibitor reversed the effects of propofol on cell viability, apoptosis, and protein expression (P<0.05 or P<0.01). In conclusion, propofol might be an ideal anesthetic for lung cancer surgery by effectively inhibiting lung cancer cell viability and inducing cell apoptosis. Modulation of miR-486 might contribute to the anti-tumor activity of propofol.

Chelation Therapy for Nickel Allergy

ABSTRACT By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this column is to focus on some of the more common drugs used in dermatology, specifically their mechanism of action, how they are utilized, and routine alternatives (if available). This article revisits the history of chelation therapy for nickel allergy; discusses its role in dermatology with an emphasis on the mechanism of action, adverse effects, and how it compares with alternative treatment options; and highlights the future implications in medical therapy.

The Impact of Volatile Anesthetic Choice on Postoperative Outcomes of Cardiac Surgery: A Meta-Analysis.

Objectives To evaluate the impact of volatile anesthetic choice on clinically relevant outcomes of patients undergoing cardiac surgery. Methods Major databases were systematically searched for randomized controlled trials (RCTs) comparing volatile anesthetics (isoflurane versus sevoflurane) in cardiac surgery. Study-level characteristics, intraoperative events, and postoperative outcomes were extracted from the articles. Results Sixteen RCTs involving 961 patients were included in this meta-analysis. There were no significant differences between both anesthetics in terms of intensive care unit length of stay (SMD −0.07, 95% CI −0.38 to 0.24, P = 0.66), hospital length of stay (SMD 0.06, 95% CI −0.33 to 0.45, P = 0.76), time to extubation (SMD 0.29, 95% CI −0.08 to 0.65, P = 0.12), S100β (at the end of surgery: SMD 0.08, 95% CI −0.33 to 0.49, P = 0.71; 24 hours after surgery: SMD 0.21, 95% CI −0.23 to 0.65, P = 0.34), or troponin (at the end of surgery: SMD −1.13, 95% CI −2.39 to 0.13, P = 0.08; 24 hours after surgery: SMD 0.74, 95% CI −0.15 to 1.62, P = 0.10). CK-MB was shown to be significantly increased when using isoflurane instead of sevoflurane (SMD 2.16, 95% CI 0.57 to 3.74, P = 0.008). Conclusions The volatile anesthetic choice has no significant impact on postoperative outcomes of patients undergoing cardiac surgery.

Comparison of intrathecal plain articaine and levobupivacaine with fentanyl for Caesarean section

Articaine is used as a local anesthetic for outpatient surgery because it offers rapid onset of anesthesia and short duration motor block. Levobupivacaine is often preferred for Caesarean section. We evaluated the anesthetic characteristics of fentanyl-supplemented plain articaine and levobupivacaine for Caesarean section under combine spinal epidural anesthesia. Patients undergoing Caesarean section received in random order plain articaine 40 mg (Group A, n=50) or plain levobupivacaine 10 mg (Group L, n=50) mixed with fentanyl 20 µg intrathecally. The onset and duration of sensory and motor block, first analgesic request, and hemodynamic parameters were recorded. Onset times of maximum motor block were longer in Group L than Group A (P=0,001). Time to two-segment regression of sensory block were 70 min for Group A and 90 min group L (P=0.001). Times to complete regression of motor blockade were significantly longer in group L than group A (P =0,001). To have a faster onset and shorter duration of spinal anesthesia, we recommend the use of plain articaine for Caesarean section.

Lidocaine

ABSTRACT By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this section is to focus on some of the more common substances, specifically how they work, how they are utilized, and their routine alternatives (if available). The mechanism of action, usage, and alternatives of the medication lidocaine are discussed.

A Bayesian network meta-analysis for binary outcome: how to do it

This study presents an overview of conceptual and practical issues of a network meta-analysis (NMA), particularly focusing on its application to randomised controlled trials with a binary outcome of interest. We start from general considerations on NMA to specifically appraise how to collect study data, structure the analytical network and specify the requirements for different models and parameter interpretations, with the ultimate goal of providing physicians and clinician-investigators a practical tool to understand pros and cons of NMA. Specifically, we outline the key steps, from the literature search to sensitivity analysis, necessary to perform a valid NMA of binomial data, exploiting Markov Chain Monte Carlo approaches. We also apply this analytical approach to a case study on the beneficial effects of volatile agents compared to total intravenous anaesthetics for surgery to further clarify the statistical details of the models, diagnostics and computations. Finally, datasets and models for the freeware WinBUGS package are presented for the anaesthetic agent example.

Topical Metronidazole in the Management of Rosacea

ABSTRACT By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this section is to focus on some of the more common substances, specifically how they work, how they are utilized, and routine alternatives (if available). This article gives an overview of rosacea and discusses the role of topical metronidazole in the management of rosacea as well as details the mechanism of action, adverse effects, and alternative treatments.

Effective Awake Thoracic Epidural Anaesthetic for Major Abdominal Surgery in Five High-Risk Elective and Emergency Patients with Severe Pulmonary Disease - A Case Report

Effective Awake Thoracic Epidural Anaesthetic for Major Abdominal Surgery in Five High-Risk Elective and Emergency Patients with Severe Pulmonary Disease - A Case Report

Cardiac troponins and volatile anaesthetics in coronary artery bypass graft surgery: A systematic review, meta-analysis and trial sequential analysis.

Reports from animal studies indicate that volatile anaesthetics protect the myocardium against the effects of acute ischaemia-reperfusion injury by reducing infarct size. This cardioprotective effect in the clinical setting of coronary artery bypass graft (CABG) surgery, where the heart is subjected to global ischaemia-reperfusion injury, remains controversial. The objective was to demonstrate that clinical studies investigating the cardioprotective effect of volatile anaesthetics on cardiac troponins in CABG are no longer warranted. We also investigated the effect of volatile anaesthetics on cardiac enzymes in off-pump cardiac surgery. Systematic review of randomised clinical trials, meta-analyses and trial sequential analysis (TSA). Trials between January 1985 and March 2015 were obtained from electronic databases (Medline, Excerpta Medica Database (EMBASE), Cochrane Controlled Trial Register, abstracts from major anaesthesiology and cardiology journals and reference lists of relevant randomised trials and review articles. Relevant randomised clinical trials were included. We investigated the effect of volatile anaesthetics in both off-pump and on-pump CABG surgery with respect to troponin release [peak postoperative cardiac troponin I (cTnI) and cardiac troponin T (cTnT), cTnI/cTnT] and performed two separate meta-analyses. TSA was used to overcome the weakness of a type-1 error associated with repeated meta-analyses. From 30 studies, 2578 patients were pooled for the meta-analysis. The outcome significantly favours the use of peroperative volatile over non-volatile anaesthetics during on-pump CABG surgery with regard to peak postoperative cTnI (0.995 mg l; standard mean difference, 95% confidence interval, -1.316 to -0.673; P < 0.001). Meta-analysis of 11 off-pump studies showed no difference in peak postoperative cTnI (0.385 mg l; standard mean difference, 95% confidence interval, -0.857 to 0.087; P = 0.11). TSA indicated that the required information size for on-pump surgery was 1072 patients, and for off-pump surgery it was 1442; this latter figure has not yet been reached. Studies investigating the cardioprotective effect of volatile anaesthetics on cardiac troponins in on-pump CABG surgery are no longer warranted. This is not yet the case for off-pump surgery.

Cardiac troponins and volatile anaesthetics in on-pump coronary surgery: How much longer do we need to state the obvious?

Cardiac troponins and volatile anaesthetics in on-pump coronary surgery: How much longer do we need to state the obvious?

Developing transcutaneous nanoenabled anaesthetics for eyelid surgery

PurposeLocal anaesthesia in eyelid surgery carries inherent risks, which has spurned ongoing investigation to identify needleless alternatives. Nanomedicines (particles ranging between 10 nm and 1000 nm in size) have shown...

Studying the influence of enflurane, isoflurane, and sevoflurane on the DPPC lipid bilayer using the analysis of variance and parallel factor analysis

The optimization of anesthetic dosage requires a clear understanding of the exact mechanism of an anesthetic action. To date, it is still not clear whether the mechanism involves the direct binding of the anesthetic molecule to the transmembrane protein or is based on the indirect influence of the protein activity throughout the perturbation of membrane lipids.The aim of this study was to clarify the mechanism of the anesthetic action of enflurane, isoflurane, and sevoflurane, which are preferred inhalation anesthetics in modern surgery due to their low toxicity and high lipid solubility. For this purpose, the influence of different concentrations of enflurane, isoflurane, and sevoflurane on the structural modification of the lipid membrane at various temperatures was studied using fluorescent probe spectroscopy. The resulting experimental multi-way excitation-emission data organized as temperatures × excitation wavelengths × emission wavelengths × anesthetic concentrations × type of anesthetic was explored and interpreted with a methodology combining analysis of variance (ANOVA) and parallel factor analysis (PARAFAC), which is in agreement with the underlying design of the experiment.The results suggest an indirect mechanism of action for all three anesthetics. Specifically, the strongest liquidizing effect is characteristic for sevoflurane thus indicating the weaker anesthetic action. Furthermore, the ‘temperature × anesthetic’ interaction factor is statistically insignificant, which confirms that the formation of an interdigitated phase does not depend on temperature. A transition from the gel-to-liquid-crystalline phase is observed due to the incorporation of sevoflurane into the bilayer, while the transition from an interdigitated to liquid-crystalline phase is due to the influence of enflurane and isoflurane on the bilayer.

Cantharidin

By definition, a drug is a medicine or substance that exerts a physiologic effect on an organism. In dermatology, medications and substances are utilized on a daily basis from topical treatments to anesthetics in micrographic surgery. The purpose of this column is to focus on some of the more common drugs used in dermatology, specifically their mechanism of action, how they are utilized, and routine alternatives (if available). This article revisits the history of cantharidin; discusses its role in dermatology with an emphasis on the mechanism of action, adverse effects, and how it compares with alternative treatment options; and highlights the future implications in medical therapy.

Propensity Score–Matched Comparison of Postoperative Adverse Outcomes Between Geriatric Patients Given a General or a Neuraxial Anesthetic for Hip Surgery

Background:The effects of the mode of anesthesia on major adverse postoperative outcomes in geriatric patients are still inconclusive. The authors hypothesized that a neuraxial anesthetic (NA) rather than a general anesthetic (GA) would yield better in-hospital postoperative outcomes for geriatric p

Evaluation of the efficacy and safety of a standardised intracameral combination of mydriatics and anaesthetics for cataract surgery

Background/aimsTo compare the efficacy and safety of intracameral (IC) administration at the beginning of cataract surgery, of Mydrane, a standardised ophthalmic combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%,...

Cardioand neuroprotection with volatile anesthetics in cardiac surgery

The researcher's opinions about myocardial and brain anesthetic preconditioning efficiency are yet contradictive. In addition, the anesthetic neuroprotection phenomenon is poorly investigated. In this study the authors attempted to evaluate the efficiency of myocardial and central nervous system (CNS) protection by using a modified method of volatile induction and maintenance of anesthesia (VIMA) based on pulse-like sevoflurane dosing that excludes propofol usage. Ninety CABG patients aged 45-75 years were included in the study group (VIMA) and underwent volatile induction with sevoflurane and anesthetic preconditioning (2 MAC) for 10 min before aortic cross-clamping, with ataralgesia used during CPB. The control group patients (TIVA) received propofol and fentanyl, no inhalation anesthetics were applied. Preoperative concentrations of NTpro-BNP were comparable. There was no significant rise of NTpro-BNP concentration in the VIMA group during the postoperative period. In the TIVA group NTpro-BNP concentrations were 3.8 and 4.8 times as much as the baseline values at 24 and 48 postoperative hours respectively (р&lt;0.05). 17 patients in the VIMA group needed dopamine infusion during 24 postoperative hours, this number was 1.7 times less than that in the TIVA group (23 patients) (р&lt;0.05). VIMA patients had 2-fold lower troponin T concentration in 24 hours after surgery (р&lt;0.01). Significant differences in protein S100B concentrations were observed only during the postoperative period. No significant differences in cognitive functions of the patients from both groups were identified before surgery. On postoperative day 2 MMSE scale count was significantly lower in TIVA patients (20.843.73) in comparison with VI-MA patients (23.364.34) (р&lt;0.05). Thus, the modified VIMA technique with sevoflurane has a greater neuroprotective potential during CABG with CPB and provides better preservation of myocardium structural integrity and cardiac performance than fentanyl/4propofol-based TIVA would do.

Xenon anaesthesia for patients undergoing off-pump coronary artery bypass graft surgery: a prospective randomized controlled pilot trial

Off-pump coronary artery bypass (OPCAB) surgery carries a high risk for haemodynamic instability and perioperative organ injury. Favourable haemodynamic effects and organ-protective properties could render xenon an attractive anaesthetic for OPCAB surgery. The primary aim of this study was to assess whether xenon anaesthesia for OPCAB surgery is non-inferior to sevoflurane anaesthesia with regard to intraoperative vasopressor requirements. Forty-two patients undergoing elective OPCAB surgery were enrolled in this prospective, single-blind, randomized controlled pilot trial. Patients were randomized to either xenon (50-60 vol%) or sevoflurane (1.1-1.4 vol%) anaesthesia. Primary outcome was intraoperative noradrenaline requirements necessary to achieve predefined haemodynamic goals. Secondary outcomes included safety variables such as the occurrence of adverse events (intraoperatively and during a 6-month follow-up after surgery) and the perioperative cardiorespiratory and inflammatory profile. Baseline and intraoperative data did not differ between groups. Xenon was non-inferior to sevoflurane, as xenon patients required significantly less noradrenaline intraoperatively to achieve the predefined haemodynamic goals {geometric mean 428 [95% confidence interval (CI) 312, 588] vs 1702 [1267, 2285] µg, P<0.0001}. No differences were found for safety. Significantly more sevoflurane patients developed postoperative delirium (POD) (hazard ratio 4.2, P=0.044). The average arterial pressure was lower in the sevoflurane group {median75 [interquartile range (IQR) 6] vs 72 [4] mmHg, P=0.002}. No differences were found for other haemodynamic parameters, the respiratory profile and the perioperative release of inflammatory cytokines, troponin T, serum protein S-100β and erythropoietin. Compared with sevoflurane, xenon anaesthesia allows a significant reduction in vasopressor administration in OPCAB surgery. Moreover, xenon anaesthesia was associated with a lower risk for POD, a finding that has to be confirmed in larger studies. ClinicalTrials.gov (NCT01757106) and EudraCT (2012-002316-12).

Consciencia, cognición y redes neuronales: nuevas perspectivas

A detailed analysis of the literature on consciousness and cognition mechanisms based on the neural networks theory is presented.The immune and inflammatory response to the anesthetic-surgical procedure induces modulation of neuronal plasticity by influencing higher cognitive functions. Anesthetic drugs can cause unconsciousness, producing a functional disruption of cortical and thalamic cortical integration complex.The external and internal perceptions are processed through an intricate network of neural connections, involving the higher nervous activity centers, especially the cerebral cortex. This requires an integrated model, formed by neural networks and their interactions with highly specialized regions, through large-scale networks, which are distributed throughout the brain collecting information flow of these perceptions.Functional and effective connectivity between large-scale networks, are essential for consciousness, unconsciousness and cognition. It is what is called the “human connectome” or map neural networks.

Changes in Rat Brain MicroRNA Expression Profiles Following Sevoflurane and Propofol Anesthesia.

Background:Sevoflurane and propofol are widely used anesthetics for surgery. Studies on the mechanisms of general anesthesia have focused on changes in protein expression properties and membrane lipid. MicroRNAs (miRNAs) regulate neural function by altering protein expression. We hypothesize that sevoflurane and propofol affect miRNA expression profiles in the brain, expect to understand the mechanism of anesthetic agents.Methods:Rats were randomly assigned to a 2% sevoflurane group, 600 μg·kg−1·min−1 propofol group, and a control group without anesthesia (n = 4, respectively). Treatment group was under anesthesia for 6 h, and all rats breathed spontaneously with continuous monitoring of respiration and blood gases. Changes in rat cortex miRNA expression profiles were analyzed by miRNA microarrays and validated by quantitative real-time polymerase chain reaction (qRT-PCR). Differential expression of miRNA using qRT-PCR among the control, sevoflurane, and propofol groups were compared using one-way analysis of variance (ANOVA).Results:Of 677 preloaded rat miRNAs, the microarray detected the expression of 277 miRNAs in rat cortex (40.9%), of which 9 were regulated by propofol and (or) sevoflurane. Expression levels of three miRNAs (rno-miR-339-3p, rno-miR-448, rno-miR-466b-1*) were significantly increased following sevoflurane and six (rno-miR-339-3p, rno-miR-347, rno-miR-378*, rno-miR-412*, rno-miR-702-3p, and rno-miR-7a-2*) following propofol. Three miRNAs (rno-miR-466b-1*, rno-miR-3584-5p and rno-miR-702-3p) were differentially expressed by the two anesthetic treatment groups.Conclusions:Sevoflurane and propofol anesthesia induced distinct changes in brain miRNA expression patterns, suggesting differential regulation of protein expression. Determining the targets of these differentially expressed miRNAs may help reveal both the common and agent-specific actions of anesthetics on neurological and physiological function.

Can Anaesthetic and Analgesic Techniques for Cancer Surgery Affect Cancer Recurrence and Metastasis?

Cancer is a leading cause of morbidity and mortality. Surgical resection of primary tumours may be curative; however, mortality from metastasis remains high. Metastasis is a complex process and cancer cells need to evade the host’s immune system and the ability to proliferate, migrate, invade adjacent tissues and angiogenesis, in order to successfully metastasise. At the time of surgery, a number of conflicting factors may influence the development of tumour metastases. Recently, it has been hypothesized that perioperative factors including anaesthetic and analgesic techniques could affect metastasis after cancer surgery. This review summarises the current evidence supporting and refuting this hypothesis from experimental, animal and retrospective clinical studies. The results of ongoing, prospective clinical trials are required before a causal effect of anaesthetic–analgesic technique on metastasis can be proven.