General Anesthetic Research Articles

PDOC-01 THERAPEUTIC DIFFICULTY IN THE MANAGEMENT OF A RECURRENT CRANIOPHARYNGIOMA IN A CHILD: REVIEW OF THE LITERATURE AND CASE REPORT

Abstract BACKGROUND Craniopharyngiomas are rare, benign epithelial tumors of embryonic origin in children that develop along the craniopharyngeal duct from Rathke’s pouch. The optimal treatment algorithm remains challenging. We report a child case of recurrent craniopharyngioma with therapeutic challenges. CASE PRESENTATION 12-year-old patient, followed for a multi-operated type 2 craniopharyngioma (December 2017, November 2018, and April 2022), stroke on left sylvian stenosis with right hemiplegia in 2020 during proton therapy (52 Gray), thrombolysed with good recovery after rehabilitation, sequellar panhypopituitarism. He was seen in consultation for visual field deterioration. Clinical examination showed a conscious, coherent, obese patient with a deteriorating visual field. Ophthalmological examination showed visual acuity 10/10 with slight temporal visual field amputation on the left and monocular blindness on the right due to probable optic atrophy sequelae of the craniopharyngioma. Magnetic resonance imaging revealed progression of the residual multicystic lesion in the sellar and left temporal regions, entering the sylvian valley and severely compressing the optic pathways. The tumor was removed under general anesthetic in a supine position, with release of the optic nerve, the carotid artery, and its division, and the left 3rd cranial nerve. The postoperative course is straightforward. CONCLUSION Morbidity and the assessment of sequelae are now at the forefront of the management of craniopharyngiomas. The current therapeutic approach should be reconsidered, in terms of the indications for surgery and the surgical protocol. This patient’s case is a typical example of the therapeutic difficulties involved in the management of craniopharyngiomas.

Successful Use of Propofol After Failed Palliative Sedation in Patients With Refractory Symptoms.

Context: Propofol is a general anesthetic used in multiple clinical scenarios. Despite growing evidence supporting its use in palliative care, propofol is rarely used in palliative sedation. Reluctance toward the adoption of propofol as a sedative agent is often associated with fear of adverse events such as respiratory arrest. Objectives: We aimed to describe efficacy and safety of palliative sedation in refractory sedation with propofol using a protocol based on low, incremental dosing. Methods: A retrospective observational study featuring inpatients receiving sedative treatment with propofol in our palliative care unit in Madrid (Spain) between March 1, 2018 and February 28, 2023, following a newly developed protocol. Results: During the study period, 22 patients underwent sedation with propofol. Propofol was used successfully to control different refractory symptoms, mainly psychoexistential suffering and delirium. All patients had undergone previous failed attempts at sedation with other medications (midazolam or lemovepromazine) and presented risk factors for complicated sedation. All patients achieved satisfactory (profound) levels of sedation measured with the Ramsay Sedation Scale, but total doses varied greatly between patients. Most patients (17, 77%) received combined therapy with propofol and other sedative medications to harness synergies. The median time between start of sedation with propofol and death was 26.0 hours. No cases of apnea or death during induction were recorded. Conclusion: A protocol for palliative sedation with propofol based on low, incremental dosing, with the option of administering an initial induction bolus, shows excellent results regarding adequate levels of sedation, without observing apnea or respiratory depression. Our results promote the use of propofol to achieve palliative sedation in patients with refractory symptoms and risk factors for complicated sedation at the end of life.

Caudal analgesia application with bupivacaine in a pediatric patient with glucose-6-phosphate dehydrogenase enzyme deficiency; case report

Glucose-6-phosphate dehydrogenase enzyme has a cells protecting feature from oxidative damage. Glucose-6-phosphate Dehydrogenase Enzyme Deficiency is a hereditary disease that causes hemolysis in cases of deficiency due to mutation in the X chromosome, due to oxidative stresses such as some drugs, chemicals or infection. The preoperative Hb of a 4-year-old patient who was to undergo circumcision surgery was determined as 8.9 g/dL. Since increased bleeding was not expected during this procedure, no attempt was made to increase the hemoglobin value. After the induction of general anesthesia with sevoflurane 8%, 1 ml/kg of 0.25% bupivacaine was administered caudally to the patient. The hemodynamic findings remained within normal limits during the surgical procedure. In the follow-up, it was determined that the pain score was low and that no additional analgesic drugs were required. Afterwards, no additional hematological abnormalities were detected and the patient was discharged two days later. We believe that during surgery, when routine monitoring measures are taken and conditions that may cause stress to the patient such as hypotension, hypoxemia, and dehydration are avoided, the patient's anesthesia and postoperative pain can be controlled with a general anesthetic gas such as sevoflurane and a local anesthetic such as bupivacaine, with attention to toxic doses.

Inhibition of the NLRP3/caspase-1 cascade related pyroptosis relieved propofol-induced neuroinflammation and cognitive impairment in developing rats

BackgroundNumerous preclinical studies have demonstrated that prolonged exposure to propofol (A general anaesthetics) can lead to hippocampus injury in immature brains and impact long-term learning and memory functions. Neuroinflammation plays a pivotal role in the impairment of brain function associated with early exposure to anesthetic drugs. Nevertheless, the involvement of hippocampal pyroptosis and neuroinflammation mediated by the NLRP3/caspase-1 signaling cascade in propofol-induced developmental neurotoxicity remains unclear. MethodsPostnatal day (PND) 7 SD rats, PC12 cells, and HAPI cells were used to establish propofol neurotoxicity models in vivo and in vitro, respectively. We examined the potential hippocampal injury and cognitive dysfunction caused by propofol in neonatal rats through the NLRP3/caspase-1 signaling pathway using MCC950 and VX765 to inhibit the pathway. This investigation involved assessing histological changes in the hippocampus, behavioral performance in adulthood, NLRP3-related pyroptosis indicators, and neuroinflammatory cytokines. ResultsBoth in vivo and in vitro studies have demonstrated that exposure to propofol activates the NLRP3/caspase-1 signaling cascade in the hippocampus of PND7 rats, leading to pyroptosis, neuroinflammation, and subsequent hippocampal injury and behavioral changes in adulthood. However, MCC950 and VX765 inhibit the NLRP3/caspase-1 signaling cascade, reversing the developmental neurotoxicity of propofol. ConclusionOur study findings suggest that negative regulation of NLRP3/caspase-1 activation may serve as a potential therapeutic strategy for developmental neuroinflammation induced by propofol.

Diethyl ether anaesthesia does not block local touch response in Arabidopsis thaliana

Plants can sense and respond to non-damaging mechanical stimulation such as touch, rain, or wind. Mechanical stimulation induces an increase of cytosolic calcium ([Ca2+]cyt), accumulation of phytohormones from the group of jasmonates (JAs) and activation of gene expression, which can be JAs-dependent or JAs-independent. Response to touch shares similar properties with reactions to stresses such as wounding or pathogen attack, and regular mechanical stimulation leads to changes in growth and development called thigmomorphogenesis. Previous studies showed that well-known seismonastic plants such as Venus flytrap (Dionaea muscipula) or sensitive plant (Mimosa pudica) lost their touch-induced motive responses during exposure to general volatile anaesthetic (GVA) diethyl ether. Here, we investigated the effect of diethyl ether anaesthesia on touch response in Arabidopsis thaliana. We monitored [Ca2+]cyt level, accumulation of JAs and expression of touch-responsive genes. Our results showed that none of the investigated responses was affected by diethyl ether. However, diethyl ether alone increased [Ca2+]cyt and modulated JAs-independent touch-responsive genes, thus partially activating touch response non-specifically. Together with our previous studies, we concluded that GVA diethyl ether cannot block the local rise of [Ca2+]cyt but only its systemic propagation dependent on GLUTAMATE LIKE RECEPTOR 3s (GLR3s) channels.

Demystifying the Suprazygomatic Maxillary Nerve Block in Paediatric Cleft Palate Surgery.

To consider the clinical anatomy, safety and effectiveness of the suprazygomatic maxillary nerve block in cleft palate surgery. Observational case series. Single cleft centre in the United Kingdom. Patients born with a cleft palate (with or without a cleft lip) undergoing palatal surgery between the ages of 9 months and 18 years. Introduction of suprazygomatic maxillary nerve (SZMN) block using ropivacaine 0.2% into clinical protocol in February 2023. Peri-procedure complications and post-operative opioid administration. The clinical anatomy of the SZMN block is described in a stepwise and pictorial approach from superficial to deep structures. 43 patients underwent surgical interventions involving the palate (either intravelar veloplasty, Furlow palatoplasty or bilateral myomucosal buccinator flaps for palatal lengthening). 22 patients had a general anaesthetic and local anaesthetic infiltration and 21 had an additional SZMN block. There were no local or systemic complications associated with the SZMN block. There was no difference in the total dosing of post-operative (P = .79) opioids between the groups. We demonstrate the feasibility and safety of this procedure without the use of ultrasound guidance in a heterogenous group of paediatric patients undergoing palatal surgery. Regional anaesthesia should be considered as part of the multi-modal analgesic strategy, although it may be difficult to demonstrate a change in opioid use in clinical settings where enhanced recovery techniques are established, and opioid use is already low.

FP8.2 - Sustainability Within the Abscess Pathway

Abstract Background Global warming and the current climate crisis remain a threat to global health. It is estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to general anaesthetic (GA) gases, which contributes to ongoing ozone depletion. Aims To review current practices in managing abscesses and improve sustainability within the abscess pathway in our trust. Methods Retrospective data on all patients who underwent incision and drainages (I&D) between January – July 2022 were collected and analysed. A new abscess pathway was introduced in June 2023 and departmental teaching provided to junior doctors on incision and drainage of abscesses under local anaesthetic (LA). Data on patients who underwent I&D between June – September 2023 were collected and analysed to assess the impact of the new abscess pathway. Results In the first-cycle audit, 162 patients underwent I&D, of which 119 (92%) were done under GA. Of these, 71 (60%) were suitable for LA I&Ds, 91% were admitted for their procedures. The estimated carbon footprint was 4525kg CO2e/year. In the second-cycle audit, 68 patients underwent I&D, of which 37 (76%) were done under GA. Of these, 31 (46%) were suitable for LA I&Ds, 41% were admitted for their procedures. The estimated carbon footprint was 3735kg CO2e/year. Conclusions Following implementation of the new abscess pathway, we reduced the number of patients having general anaesthetic procedures and inpatient admission. This not only improves the sustainability of our practice, but makes treatment and recovery quicker for patients, and has a lower financial burden.

ThP4.10 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter

Abstract Aim Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach in a district general hospital over a two-year period. Methods Prospectively collected data regarding all patients who underwent LC+LCBDE over a period from January 2022 to December 2023 was retrospectively reviewed. Data concerning indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel. Results 50 patients were identified. CBD diameter (as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.25mm). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-8 days) and readmission rate was 6%. One patient experienced a complication beyond Clavien-Dindo Grade 2, this caused by a superficial wound infection requiring washout under general anaesthetic. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for management of retained CBD stones. Conclusions LC+LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small common bile duct diameter. Small CBD should not necessarily be a deterrent to consideration of LCBDE as a therapeutic option in appropriately selected patients.

WP1.1 - Examining the effectiveness of prescribing Tamsulosin before elective surgery for inguino-scrotal hernias - a case series

Abstract Aims Urinary retention following surgery is a common issue that can result in significant morbidity and prolonged hospital admissions. Tamsulosin is commonly used to manage patients at risk of urinary retention in the community but its usefulness at preventing retention following surgery is currently unclear. This case series describes the effectiveness of using short courses of tamsulosin to prevent post-operative urinary retention at a single centre. Methods Males aged over 70 who underwent elective surgery for an inguino-scrotal hernia between January 2022 and January 2024 were included in this series. Inclusion also required the patients to be planned as day case procedures under general anaesthetic. Patients with a known history of prostatic disease and/or who were already taking Tamsulosin or another alpha-1 adrenoceptor inhibitor were excluded. Results 67 patients who took 400 micrograms of Tamsulosin once daily for 2 days before and on the day of surgery were included in this series. The patients were aged between 70 - 89 years and all underwent elective open mesh hernia repairs under the same surgeon with the same materials. None of the patients suffered post-operative urinary retention and so were able to be discharged as day cases. Conclusions The absence of any instances of post-operative urinary retention in this series suggests that a course of Tamsulosin before elective inguino-scrotal hernia repair can effective as prophylaxis against the condition. This data alongside additional randomised control trials demonstrating the benefits of pre-operative Tamsulosin may result in it being used more widely.

Correlation between anesthetic concentration and low Apgar scores in neonates born via Cesarean sections under general anesthesia

ObjectivesThis study aimed to compare plasma concentrations of anesthetic drugs administered during Cesarean section with low Apgar score in neonates deliveried under general anesthesia and analyze associated risk factors.MethodsData from 76 neonates undergoing Cesarean section under general anesthesia with blood concentrations of anesthetic drugs were analyzed. A low Apgar score was defined as ≤ 7. Perioperative maternal and neonatal data were collected and analyzed. Neonates were divided into a control group (Group CON, n = 65) and a low Apgar score group (Group LAS, n = 11) based on Apgar score.ResultsThere were no significant differences in the plasma concentrations of anesthetic drugs in maternal artery, umbilical vein or umbilical artery blood between the two groups. Risk factors for neonatal low Apgar scores during Cesarean section under general anesthesia were premature delivery (aOR 10.2, 95% CI = 1.8–56.9) and preoperative fetal distress (aOR 9.6, 95% CI = 1.3–69.0). The prediction model was: probability = 1/(e‑Y), Y= -4.607 + 2.318× (premature delivery) + 2.261× (fetal distress) (yes = 1, no = 0). The Hosmer–Lemeshow test showed χ²= 9.587, P = 0.213, and the area under the curve (AUC) was 0.850 (0.670 ~ 1.000). With a cutoff value of 0.695, sensitivity and specificity were 81.8% and 87.7%, respectively.ConclusionsThere was no correlation between blood concentration of general anesthetic drugs and Apgar score or occurrence of neonatal low Apgar scores. Premature delivery and preoperative fetal distress were identified as independent risk factors for neonatal low Apgar scores after Cesarean section under general anesthesia.

Dental Sedation and General Anesthesia Considerations for Patients Posthepatic Transplantation.

Hepatic compromise poses significant impacts upon the care of patients undergoing routine dental treatment. When sedation or general anesthesia is planned for dental treatment or oral and maxillofacial surgery, an understanding of basic liver function and clinical evaluation can assist in adapting treatment modifications for patients with limited function due to previous disease and resultant organ transplantation efforts. Beginning with a basic overview of hepatic physiology, this review will outline the specific functions of digestion, metabolism, synthesis, and detoxification involving the liver. Specific clinical considerations will be reviewed regarding comorbidities that develop prior to and after liver transplantation that often impact a patient's suitability for ambulatory and office-based care. Lastly, choices in both local anesthetics, sedative medications, general anesthetics, and postoperative analgesics utilized in dental treatment will be discussed.

Serum neurofilament light release levels as marker of neurotoxicity in general anesthesia versus hypnosis: A prospective non-randomized trial

Background: Whether general anesthetics induce neurotoxicity is unclear. Objectives: We hypothesized that serum neurofilament light (NfL) release, a marker of neural injury, would not be different in patients receiving general anesthesia (GA) compared to hypnosis. Design: Prospective, non-randomized. Setting: Tertiary university hospital. Methods: Patients undergoing breast cancer or thyroid/parathyroid surgery were enrolled. Propofol and remifentanil were used for GA. For hypnosis, only low dose remifentanil was allowed. Main outcome measures: NfL was measured at baseline, at day 1 and at postoperative visit. At preoperative and postoperative visit, patients performed a Montreal Cognitive Assessment (MoCA) test. Primary outcome was absolute change in NfL at day 1 between groups. Results: Among 100 included patients, 51 were in GA and 49 in hypnosis group. There were 26/49 (53%) breast cancer patients in hypnosis group and 13/51 (26%) in GA arm, p = 0.005. Baseline NfL was higher in the hypnosis group (p = 0.050). We subtracted log-transformed baseline NfL from postoperative NfL to analyze normalized values as absolute change. The mean normalized value at day 1 (primary endpoint) was 0.02 (± 0.11) in the GA and 0.03 (± 0.20) in the hypnosis group; p = 0.979 [d = 0.16, 95% CI: -0.40 to 0.39]. In a linear mixed-effects model including variables that influenced baseline NfL (advanced age, higher creatinine values, breast cancer), mean difference (95 % CI) in absolute change of log NfL at day 1 between both groups was 0.007 (- 0.04 to 0.06); p = 0.791. A change in MoCA as compared to baseline was not different between groups (p = 0.761). Conclusions: Our results show that there was no statistical or clinical difference in postoperative NfL release between GA and hypnosis. GA with propofol was not associated with a different risk of neural injury compared to hypnosis. Trial registration: NCT04500236.

Cerium oxide nanoparticles (nanoceria) pretreatment attenuates cell death in the hippocampus and cognitive dysfunction due to repeated isoflurane anesthesia in newborn rats

General anesthetics exposure, particularly prolonged or repeated exposure, is a crucial cause of neurological injuries. Notably, isoflurane (ISO), used in pediatric anesthesia practice, is toxic to the developing brain. The relatively weak antioxidant system at early ages needs antioxidant support to protect the brain against anesthesia. Cerium oxide nanoparticles (CeO2-NPs, nanoceria) are nano-antioxidants and stand out due to their unique surface chemistry, high stability, and biocompatibility. Although CeO2-NPs have been shown to exhibit neuroprotective and cognitive function-facilitating effects, there are no reports on their protective effects against anesthesia-induced neurotoxicity and cognitive impairments. Herein, Wistar albino rat pups were exposed to ISO (1.5 %, 3-h) at postnatal day (P)7+P9+P11, and the protective properties of CeO2-NP pretreatment (0.5 mg/kg, intraperitoneal route) were investigated for the first time. The control group at P7+9+11 received 50 % O2 (3-h) instead of ISO. Exposure to nanoceria one-hour before ISO protected hippocampal neurons of the developing rat brain against apoptosis [determined by hematoxylin-eosin (HE) staining, immunohistochemistry (IHC) analysis with caspase-3, and immunoblotting with Bax/Bcl2, cleaved caspase-3 and PARP1] oxidative stress, and inflammation [determined by immunoblotting with 4-hydroxynonenal (4HNE), nuclear factor kappa-B (NF-κB), and tumor necrosis factor-alpha (TNF-α)]. CeO2-NP pretreatment also reduced ISO-induced learning (at P28–32) and memory (at P33) deficits evaluated by Morris Water Maze. However, memory deficits and thigmotactic behaviors were detected in the agent-control group; elimination of these harmful effects will be possible with dose studies, thus providing evidence supporting safer use. Overall, our findings support pretreatment with nanoceria application as a simple strategy that might be used for pediatric anesthesia practice to protect infants and children from ISO-induced cell death and learning and memory deficits.

Neural Network Mechanisms Underlying General Anesthesia: Cortical and Subcortical Nuclei.

General anesthesia plays a significant role in modern medicine. However, the precise mechanism of general anesthesia remains unclear, posing a key scientific challenge in anesthesiology. Advances in neuroscience techniques have enabled targeted manipulation of specific neural circuits and the capture of brain-wide neural activity at high resolution. These advances hold promise for elucidating the intricate mechanisms of action of general anesthetics. This review aims to summarize our current understanding of the role of cortical and subcortical nuclei in modulating general anesthesia, providing new evidence of cortico-cortical and thalamocortical networks in relation to anesthesia and consciousness. These insights contribute to a comprehensive understanding of the neural network mechanisms underlying general anesthesia.

Suppressive effect of the anesthetic propofol on the T cell function and T cell-dependent immune responses

General anesthesia is thought to suppress the immune system and negatively affect postoperative infection and the long-term prognosis of cancer. However, the mechanism underlying immunosuppression induced by general anesthetics remains unclear. In this study, we focused on propofol, which is widely used for sedation under general anesthesia and intensive care and examined its effects on the T cell function and T cell-dependent immune responses. We found that propofol suppressed T cell glycolytic metabolism, differentiation into effector T cells, and cytokine production by effector T cells. CD8 T cells activated and differentiated into effector cells in the presence of propofol in vitro showed reduced antitumor activity. Furthermore, propofol treatment suppressed the increase in the number of antigen-specific CD8 T cells during Listeria infection. In contrast, the administration of propofol improved inflammatory conditions in mouse models of inflammatory diseases, such as OVA-induced allergic airway inflammation, hapten-induced contact dermatitis, and experimental allergic encephalomyelitis. These results suggest that propofol may reduce tumor and infectious immunity by suppressing the T cell function and T cell-dependent immune responses while improving the pathogenesis and prognosis of chronic inflammatory diseases by suppressing inflammation.

Timely administration of sodium citrate for cesarean delivery under general anesthesia: A retrospective analysis

Study objectiveThe ASA practice guidelines for obstetric anesthesia recommend timely administration of nonparticulate antacids before cesarean delivery to minimize risks with aspiration. The median duration of action for sodium citrate is 30 min. This study aimed to determine the timeliness of sodium citrate administration by evaluating the time between sodium citrate administration and intubation, and whether time differences exist between planned versus unplanned general anesthetics (GAs) for cesarean delivery. DesignThis was an IRB approved single center retrospective analysis of electronic medical records for all patients undergoing general anesthesia for cesarean delivery in the year 2017. Patients81 medical records of patients undergoing cesarean delivery with general anesthesia. MeasurementsThe time of sodium citrate administration, time of intubation, indication for GA, and aspiration events were extracted. Planned general anesthetics were defined as anesthetics that were carried out in the primary modality intended by the provider. The primary study outcome was the time interval between sodium citrate administration and intubation. Data were stratified by whether the general anesthetic was planned or unplanned. Main resultsOf 3014 cesarean deliveries, 81 patients underwent GA (2.7%). Sixty-seven patients received sodium citrate before intubation (83%). The median time from sodium citrate administration to intubation for planned GAs was 8 min (interquartile range, [IQR]: 5–19 min), whereas the median time for unplanned GAs was 37.5 min (IQR: 15–62 min) (P < 0.0001). There were no aspiration events. ConclusionsThe interval between sodium citrate administration and intubation exceeds the median duration of action (30 min) in unplanned general anesthetics. Timing of sodium citrate administration for unplanned GAs may occur outside the window of drug efficacy. Consideration should be given to administering sodium citrate prior to intubation, as opposed to prior to OR transfer, with the goal of avoiding a prolonged interval between administration and intubation.

Effects of general anesthesia on airway immune cell function in an equine in vivo model

ObjectiveComplications from general anesthesia, including pneumonia and decreased wound healing, are influenced by changes in immune cell function secondary to sedatives and anesthetics. It was hypothesized that immune cell function would be depressed in the early postanesthetic period. The objective was to investigate airway immune cell function before and after a general anesthetic episode in an equine in vivo model using ex vivo cell stimulations with lipopolysaccharide (LPS) for assessment of immune function. Study designProspective experimental study. AnimalsSix healthy, adult, institution-owned horses. MethodsEach horse underwent a bronchoalveolar lavage (BAL) 3 days before and immediately after a 2 hour general anesthetic. The BAL fluid was examined for cytology, total nucleated cell count and isolation of immune cells. Airway immune cells were treated with LPS or media (control) for 6 hours and supernatant was analyzed via a commercially available immunoassay for cytokines [tumor necrosis factor alpha (TNFα), interleukin (IL)-1β, IL-6, interferon gamma (IFNγ) and CXC motif chemokine ligand 8 (CXCL8)]. Data were compared using t-tests and Mann–Whitney tests. ResultsBefore anesthesia (baseline), LPS stimulation induced a significant increase in all cytokines of interest, except CXCL8, versus control samples. Unstimulated cells, after an anesthetic episode, had a significant 1.8-fold increase in IL-1β (p = 0.029), and a significant decrease in IL-6 and TNFα (p = 0.028 and 0.033, respectively) versus baseline. Following anesthesia, stimulated cells had a significant decrease in IL-6 and TNFα (p = 0.037 and 0.042, respectively) versus baseline. Conclusions and clinical relevanceThis study supports the use of an equine in vivo model to assess airway immune cell function in relation to general anesthetic use.

Rosiglitazone Promotes Oligodendrocyte Development and Myelin Formation of Repeated Neonatal Sevoflurane Exposure via PPARγ Signaling.

Sevoflurane is one of the most commonly used general anesthetics for children and infants. Recent research indicates that repeated exposure to sevoflurane in neonates induces cognitive and fine motor deficits. Peroxisome proliferator-activated receptor-γ (PPARγ) agonists have garnered significant attention as potential therapies for a variety of neurological conditions. In this research, we evaluated whether pretreatment with rosiglitazone in neonatal mice could address myelination defects, cognitive impairment, and fine motor dysfunction via PPARγ. The mice were exposed to 3% sevoflurane for 2h on postnatal days 6-8 (P6-P8). Behavioral tests were conducted from P29 to P34. Additionally, we evaluated morphological and functional changes related to myelin. Our results showed that rosiglitazone pretreatment significantly ameliorated the cognitive and fine motor impairments of repeated neonatal sevoflurane exposure. In addition, rosiglitazone pretreatment promoted oligodendrocyte precursor cells (OPCs) differentiation and myelination. This suggests that rosiglitazone may be used in clinical settings to enhance the security of neonatal sevoflurane exposure. Furthermore, PPARγ and fatty acid synthase (FASN) may be mediators for rosiglitazone, which alleviates myelination defects, cognitive impairment, and fine motor dysfunction.

Drug administration errors among anaesthesia providers in South Africa: a cross-sectional descriptive study

BackgroundDrug administration errors (DAEs) in anaesthesia are common, the aetiology multifactorial and though mostly inconsequential, some lead to substantial harm. The extend of DAEs remain poorly quantified and effective implementation of prevention strategies sparse.MethodA cross-sectional descriptive study was conducted using a peer-reviewed survey questionnaire, circulated to 2217 anaesthetists via a national communication platform. The aim was to determine the self-reported frequency, nature, contributing factors and reporting patterns of DAEs among anaesthesia providers in South Africa.ResultsOur cohort had a response rate was 18.9%, with 420 individuals populating the questionnaire. 92.5% of surveyed participants have made a DAE and 89.2% a near-miss. Incorrect route of administration, potentially resulting in serious harm, accounted for 8.2% (n = 23/N = 279) of these errors. DAEs mostly reported in cases involving adult patients (80.5%, n = 243/N = 302), receiving a general anaesthetic (71.8%, n = 216/N = 301), where the drug-administrator prepared the drugs themselves (78.7%, n = 218/N = 277), during normal daytime hours (69.9%, n = 202/N = 289) with good lightning conditions (93.0%, n = 265/N = 285). 26% (n = 80/N = 305) of DAEs involved ampoule misidentification, whilst syringe identification error reported in 51.6% (n = 150/N = 291) of cases. DAEs are often not reported (40.3%, n = 114/N = 283), with knowledge of correct reporting procedures lacking. 70.5% (n = 198/N = 281) of DAEs were never discussed with the patient.ConclusionsDAEs in anaesthesia remain prevalent. Known error traps continue to drive these incidents. Implementation of system based preventative strategies are paramount to guard against human error. Efforts should be made to encourage scrupulous reporting and training of anaesthesia providers, with the aim of rendering them proficient and resilient to handle these events.

Myelin modulates the process of isoflurane anesthesia through the regulation of neural activity.

The mechanism underlying the reversible unconsciousness induced by general anesthetics (GA) remains unclear. Recent studies revealed the critical roles of myelin and oligodendrocytes (OLs) in higher functions of the brain. However, it is unknown whether myelin actively participates in the regulation of GA. The aim of this study is to investigate the roles and possible mechanisms of myelin in the regulation of consciousness alterations induced by isoflurane anesthesia. First, demyelination models for the entire brain and specific neural nuclei were established to investigate the potential role of myelination in the regulation of GA, as well as its possible regional specificity. c-Fos staining was then performed on the demyelinated nuclei to verify the impact of myelin loss on neuronal activity. Finally, the activity of neurons during isoflurane anesthesia in demyelinated mice was recorded by optical fiber photometric calcium signal. The related behavioral indicators and EEG were recorded and analyzed. A prolonged emergence time was observed from isoflurane anesthesia in demyelinated mice, which suggested the involvement of myelin in regulating GA. The demyelination in distinct nuclei by LPC further clarified the region-specific roles of isoflurane anesthesia regulation by myelin. The effect of demyelination on isoflurane anesthesia in the certain nucleus was consistent with that in neurons towards isoflurane anesthesia. Finally, we found that the mechanism of myelin in the modulation of isoflurane anesthesia is possibly through the regulation of neuronal activity. In brief, myelin in the distinct neural nucleus plays an essential role in regulating the process of isoflurane anesthesia. The possible mechanism of myelin in the regulation of isoflurane anesthesia is neuronal activity modification by myelin integrity during GA. Our findings enhanced the comprehension of myelin function, and offered a fresh perspective for investigating the neural mechanisms of GA.