Presence Of Volatile Anesthetics Research Articles

Anesthetic Cardioprotection in Clinical Practice From Proof-of-Concept to Clinical Applications

In 2007, the American Heart Association (AHA) recommended (class IIa, level of evidence B) in their guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery volatile anesthetics as first choice for general anesthesia in hemodynamically stable patients at risk for myocardial ischemia. This recommendation was based on results from patients undergoing coronary artery bypass grafting (CABG) surgery and thus subject to criticism. However, since a "good anesthetic" often resembles a piece of art in the complex perioperative environment, and is difficult to highly standardize, it seems unlikely that large-scale randomized control trials in noncardiac surgical patients will be performed in the near future to tackle this question. There is growing evidence that ether-derived volatile anesthetics and opioids provide cardioprotection in patients undergoing CABG surgery. Since 2011, the American College of Cardiology Foundation/AHA have recommended a "volatile-based anesthesia" for these procedures (class IIa, level of evidence A). It is very likely that volatile anesthetics and opioids also protect hearts of noncardiac surgical patients. However, age, diabetes and myocardial remodeling diminish the cardioprotective benefits of anesthetics. In patients at risk for perioperative cardiovascular complications, it is essential to abandon the use of "anti-conditioning" drugs (sulfonylureas and COX-2 inhibitors) and probably glitazones. There is significant interference in cardioprotection between sevoflurane and propofol, which should not be used concomitantly during anesthesia if possible. Any type of ischemic "conditioning" appears to exhibit markedly reduced protection or completely loses protection in the presence of volatile anesthetics and/or opioids.

Out of a Cell into This Darkened Space

Out of a Cell into This Darkened Space

Halothane, Isoflurane, and Sevoflurane Increase the Kinetics of Ca2+-Induced Conformational Change of Recombinant Human Cardiac Troponin C

Halothane, isoflurane, and sevoflurane exert negative inotropic side effects, generally mediated via a reduced availability of intracellular calcium. Other possible mechanisms include modified intracellular calcium handling, impaired actomyosin cross-bridge cycling, and/or alteration of calcium-induced conformational changes of the regulatory troponin complex. We investigated the effect of halothane, isoflurane, and sevoflurane on calcium-dependent kinetics of isolated human recombinant cardiac troponin C labeled with IAANS (HrcTnC(IAANS)) using stopped-flow and calcium titration techniques. Calcium concentration at half-maximal fluorescence intensity (K(d)) in the control group was 2.1 +/- 0.1 mM. Volatile anesthetics increased calcium sensitivity in a concentration-dependent fashion sevoflurane (K(d) 1.5-1.7 mM, P = 0.001) > halothane (K(d) 1.7-1.9 mM, P < 0.01) > isoflurane (K(d) 1.8-1.9 mM, P < 0.05). The rate constant of conformational changes after rapid dissociation of calcium from HrcTnC(IAANS) (k(off(c))) was moderately prolonged at 4 degrees C by halothane and isoflurane > sevoflurane. These mechanisms may counteract the effects of lower calcium availability, and can be responsible for abbreviated, and possibly incomplete, relaxation of cardiac muscle fibers in the presence of volatile anesthetics.

Differential Inhibition of Neuronal Na+–Ca2+Exchange versus Store-operated Ca2+Channels by Volatile Anesthetics in Pheochromocytoma (PC12) Cells

Ca2+ influx is a key component of neuronal intracellular Ca2+ ([Ca2+]i) regulation. The authors hypothesized that volatile anesthetic inhibition of neuronal activity is mediated by inhibition of Ca2+ influx via two major mechanisms: plasma membrane Na+-Ca2+ exchange (NCX) and the novel mechanism of Ca2+ influx triggered by endoplasmic reticulum Ca2+ depletion (store-operated Ca2+ channels [SOCCs]). Differentiated rat pheochromocytoma cells loaded with the Ca2+ indicator fura-2 were Na+-loaded with 0 Ca2+, 145 mm Na+ Tyrode's and 5 microm cyclopiazonic acid plus 10 microm ryanodine (functionally isolating plasma membrane). Influx-mode NCX was rapidly reactivated by 0 Na+ and 2.5 mm Ca2+. The protocol was repeated in the presence of volatile anesthetics (0.5-1.5 minimum alveolar concentration [MAC] halothane, isoflurane, or sevoflurane) or other drugs to characterize NCX. To examine SOCCs, endoplasmic reticulum Ca2+ was depleted by cyclopiazonic acid in 0 extracellular Ca2+, and Ca2+ influx was triggered by rapid reintroduction of extracellular Ca2+. The protocol was repeated in the presence of anesthetics or other drugs to characterize SOCCs. Influx via NCX was not inhibited by voltage-gated Ca2+ channel blockers but was sensitive to NCX inhibitors. Halothane and isoflurane (0.5-1.5 MAC) significantly inhibited NCX (P < 0.05; paired comparisons), whereas sevoflurane at less than 1.5 MAC did not inhibit NCX. SOCC-mediated Ca2+ influx was insensitive to a variety of Ca2+ channel blockers but was inhibited by Ni2+. Such influx was sensitive only to halothane at greater than 1 MAC but not isoflurane or sevoflurane. These data indicate that volatile anesthetics, especially halothane and isoflurane, interfere with neuronal [Ca2+]i regulation by inhibiting NCX but not SOCC-mediated Ca2+ influx (except high concentrations of halothane).

Extracellular magnesium ion modifies the actions of volatile anesthetics in area CA1 of rat hippocampus in vitro.

Magnesium ion (Mg2+) is involved in important processes as modulation of ion channels, receptors, neurotransmitter release, and cell excitability in the central nervous system. Although extracellular Mg2+ concentration ([Mg2+]o) can be altered during general anesthesia, there has been no evidence for [Mg2+]o-dependent modification of anesthetic actions on neural excitability in central nervous system preparations. The purpose of current study was to determine whether the effects of volatile anesthetics are [Mg2+]o-dependent in mammalian central nervous system. Extracellular electrophysiologic recordings from CA1 neurons in rat hippocampal slices were used to investigate the effects of [Mg2+]o and anesthetics on population spike amplitude and excitatory postsynaptic potential slope. The depression of population spike amplitudes and excitatory postsynaptic potential slopes by volatile anesthetics were significantly dependent on [Mg2+]o. The effects were attenuated in the presence of a constant [Mg2+]o/extracellular Ca2+ concentration ratio. However, neither N-methyl-d-aspartate receptor antagonists nor a non-N-methyl-d-aspartate receptor antagonist altered the [Mg2+]o-dependent anesthetic-induced depression of population spikes. Volatile anesthetics produced minimal effects on input-output (excitatory postsynaptic potential-population spike) relations or the threshold for population spike generation. The effects were not modified by changes in [Mg2+]o. In addition, the population spike amplitudes, elicited via antidromic (nonsynaptic) stimulation, were not influenced by [Mg2+]o in the presence of volatile anesthetics. These results provide support that alteration of [Mg2+]o modifies the actions of volatile anesthetics on synaptic transmission and that the effects could be, at least in part, a result of presynaptic Ca2+ channel-related mechanisms.

Volatile anaesthetics reduce adhesion of blood platelets under low‐flow conditions in the coronary system of isolated guinea pig hearts

Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far. Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined. At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1 +/- 1.2% (mean +/- SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2 +/- 1.2%), sevoflurane (to 4.4 +/- 0.9%) or halothane (to 3.2 +/- 1.5%) (each P < 0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics. Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.

Effect of Volatile Anesthetics With and Without Verapamil on Intracellular Activity in Vascular Smooth Muscle

Comment: This sophisticated, detailed, and meticulously worked laboratory report furnishes further data on the intracellular mechanisms of action of halothane and isoflurane in preparations of rat thoracic aorta smooth muscle strips and the interactions of calcium and calcium channel blockers (in this case, verapamil). Previous studies on the interaction of verapamil with volatile anesthetics suggested that verapamil abolished the decrease in cardiac output induced by low calcium and exaggerated the increase in stroke volume and left ventricular contractility induced by high levels of calcium.1 The effects of calcium channel blockers when used in combination with enflurane were also studied and were an exaggeration of the reduction of cardiac output and stroke volume induced by hypocalcemia. Other studies comparing the combination of nifedipine and volatile anesthetics found the prime interaction to be with enflurane, causing an exaggerated reduction in atrial rate and contractility unaccompanied by any effects on atrioventricular conduction.2 The impact of verapamil on enflurane was not examined in this study. The clinical implications regarding the use of calcium channel blockers in the presence of volatile anesthetics from these in vivo and in vitro studies are, as yet, unclear.

Effects of volatile anaesthetics on human neutrophil oxidative response to the bacterial peptide FMLP

Summary The oxidative burst response of neutrophils to bacteria is crucial for effective host defence. It has been shown that inhalation anaesthetics interfere with neutrophil function and the object of this study was to characterize the mechanisms of interaction of volatile anaesthetics with the oxidative response of neutrophils. H2O2 production by neutrophils after stimulation with the bacterial peptide, N-formyl-L-methionyl-L-leucyl-phenylalanine (FMLP) and phorbol-12-myristate-13-acetate (PMA) was measured by oxidation of the indicator dye dihydrorhodamine using flow cytometry. FMLP binds to a specific surface receptor on neutrophils and initiates via receptor specific signal transduction respiratory burst as an all-ornone event, whereas PMA is an artificial activator of protein kinase C, which bypasses receptormediated signal transduction. In the presence of halothane, enflurane and sevoflurane, there was an increase in activation threshold on FMLP stimulation. Overall, this correlated with reduced H2O2 production. Isoflurane had no effect. In the presence of desflurane, however, H2O2 production of neutrophils increased two-fold, followed by transient suppression of neutrophil function. PMAinduced H2O2 generation was unchanged in the presence of volatile anaesthetics. We conclude that volatile anaesthetics modulated FMLP receptordependent signal transduction upstream of protein kinase C activation, leading to a reduced response in the presence of halothane, enflurane and sevoflurane and to an increased response in the presence of desflurane. (Br. J. Anaesth. 1997; 78: 718–723). Immune response. Blood, leucocytes. Blood, neutrophils. Anaesthetics volatile, desflurane. Anaesthetics volatile, enflurane. Anaesthetics volatile, halothane. Anaesthetics volatile, isoflurane. Anaesthetics volatile, sevoflurane.

Volatile anaesthetic effects on calcium conductance of planar lipid bilayers formed with synthetic lipids or extracted lipids from sarcoplasmic reticulum

Volatile anaesthetics are known to increase leakage of calcium from the light fraction of skeletal sarcoplasmic reticulum (L-SR) which has no calcium release channels. To explore the role of the lipid environment, we have examined the effect of volatile anaesthetics on calcium conductance (gCa) of lipid membranes. Planar lipid bilayers were formed with a mixture of synthetic phospholipids and cholesterol, resembling the composition of SR membranes, or with lipids extracted from skeletal L-SR, gCa was estimated by calculating the calcium transference number (tCa) using diffusion potential measurements. Membranes formed with L-SR-extracted lipids had a higher gCa than membranes formed with synthetic lipids. Volatile anaesthetics increased total conductance and gCa in a dose-dependent manner, but did not affect tCa or membrane specific capacitance. In membranes formed with L-SR-extracted lipids, isoflurane induced the largest increase in gCa (1260 (SEM 304) % increase, n = 4, 0.94 mmol litre-1), followed by enflurane (264 (75)%, n = 5, 1.88 mmol litre-1) and halothane (53 (33)%, n = 5; 1.54 mmol litre-1). In membranes formed with synthetic lipids, volatile anaesthetic-induced increases in gCa followed the same trend but were larger. Volatile anaesthetics increased gCa without changing the ionic selectivity of membranes. However, the magnitude of the increase in gCa in the presence of volatile anaesthetics cannot account for the previously observed calcium leakage from L-SR vesicles. Therefore, the volatile anaesthetic-induced increase in calcium leakage in L-SR vesicles must be mediated via other pathways involving membrane proteins.

Messung der Atem-Alkoholkonzentration mit einem neuen elektrochemischen Sensor Modelluntersuchung zur Querempfindlichkeit gegen�ber volatilen An�sthetika und klinische Anwendung

Absorption of irrigating fluid in transurethral prostatic resection (TURP) and percutaneous nephrolitholapaxy (PNL) into veins or delayed absorption due to fluid extravasation may result in a TURP syndrome. The measurement of end-tidal breath alcohol concentration (et AC) as a monitor of absorption of irrigating fluid labelled with 2% ethanol is limited by the disturbance of infrared sensors by volatile anaesthetics and nitrous oxide (N2O) (Fig. 2). An electrochemical sensor is acceptable for this method. The aim of the present study was the evaluation of breath alcohol measurements using an electrochemical sensor device (Alcomed 3010, Envitec). The stability of the sensor in the presence of volatile anaesthetics was examined using a lung model. In a clinical investigation, the device was then applied to spontaneously breathing or mechanically ventilated patients inhaling volatile anaesthetics during endoscopic urological surgery. A two-chamber lung model filled with water for performing noninvasive measurements at the mouth of a patient has already been introduced by Brunner et al. (Fig. 1). With the addition of different amounts of ethanol to the temperature-controlled water, a constant ethanol concentration is achievable in the air above the water that is dependent on adjustments of the ventilator. Increasing concentrations of volatile anaesthetics (isoflurane, enflurane, halothane, and sevoflurane) were added to the fresh gas flow (2 l O2/3 l N2O) and etACs were measured using the manually triggered self-absorbent electrochemical sensor. First, regression equations were established between breath alcohol concentrations and increased volatile anaesthetic concentrations. Regression equations were then established between end-tidal anaesthetic gas concentrations and vaporizer adjustments in order to rule out an influence of ethanol on the anaesthetic gas monitor Ultima V (Datex). In the clinical investigation, 53 intubated and ventilated patients (33 undergoing PNL, 20 undergoing TURP) and 48 patients breathing spontaneously (32 with inhalation anaesthesia, 16 with spinal anaesthesia) were investigated. The etAC was measured with the Alcomed 3010 and compared with gas-chromatographically registered blood alcohol concentrations (BAC). The study had previously been approved by the Ethical Committee of the Medical University of Luebeck. Patients with liver disease and a history of toxic abuse were excluded. Only one value per patient (maximum BAC) was included in the statistics in order to avoid a cluster effect. The lung model experiments demonstrated that the measurement of etAC with an electrochemical sensor is free of interference by volatile anaesthetics (Table 1). The slope of the regression between the measured alcohol concentration and increased concentrations of anaesthetics did not differ significantly from baseline values. The measurement of end-tidal anaesthetic concentrations was not significantly different from vaporizer adjustments in the presence of increased alcohol concentrations (Table 2). During the clinical investigation, a regression between etAC and BAC was determined for both groups. For the group of patients breathing spontaneously, the correlation coefficient was 0.961 and the regression equation revealed etAC = 0.5677*BAC-0.1303 (Fig. 5). However, in the group of ventilated patients a biphasic course was shown that was dependent on BAC (Fig. 6). At BAC < 0.4%, a similar correlation (r = 0.856) to the spontaneously breathing group could be seen (regression equation: etAC = 0.617*BAC-0.020). Above 0.4% BAC there was no acceptable correlation (r = 0.444, regression equation: etAC = 0.202*BAC+0.104). The tested electrochemical sensor does not interfere with volatile anaesthetics and N2O as demonstrated by a lung model. There is a good correlation between etAC and BAC measurements in patients breathing spontaneously with special regard to the slope of the regression (s = 0.57).

Recovery of Function and Adenosine Triphosphate Metabolism Following Myocardial Ischemia Induced in the Presence of Volatile Anesthetics

Using a normothermic isolated working rabbit heart model, experiments were performed to determine whether exposure to halothane or isoflurane prior to ischemia improved postischemic recovery of myocardial function and the preservation of myocardial high energy phosphates. After 30 min of Langendorff perfusion, hearts were perfused for 30 min in the working mode. Three groups were studied: 1) the blank undergoing no pretreatment during an additional 15 min of working mode; 2) hearts exposed to 1.5% halothane; and 3) hearts exposed to 2.3% isoflurane during the additional 15 min of working mode. Subsequently, all hearts underwent 15 min of global normothermic ischemia, followed by 5 min of Langendorff reperfusion and 15 min of working heart mode using a perfusate devoid of volatile anesthetic. Adenosine triphosphate (ATP) and catabolites were determined after 15 min exposure to volatile anesthetics or blank, after 15 min global ischemia and at the end of the recovery phase. Myocardial function was determined after 30 min of working mode, after exposure to volatile anesthetics, and at the end of the recovery phase. In nonischemic hearts, 15-min treatment with 1.5% halothane or 2.3% isoflurane resulted in a significant decrease in positive LVdP/dt, from 1858 +/- 286 to 1316 +/- 180 mm Hg.s-1 and from 1888 +/- 304 to 1541 +/- 226 mm Hg.s-1, respectively. Coronary flow was increased significantly after isoflurane but not after halothane.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of hypoxemia on regional blood flows during anesthesia with halothane, enflurane, or isoflurane.

Hypoxemia during anesthesia can cause severe morbidity and mortality. To determine how the volatile anesthetics alter the normal hemodynamic compensation for hypoxemia, we investigated the effects of various anesthetics on regional blood flows during normoxemia and during normocapnic hypoxemia (FIO2 0.12 for 20 min) in rats. Using the radioactive microsphere method, organ blood flows were determined in animals anesthetized with 1 MAC of halothane, enflurane, or isoflurane and in awake animals. Brain blood flow increased significantly with hypoxemia in awake animals. However, brain blood flow decreased in all anesthetized animals that were hypoxemic. Coronary blood flow also increased significantly with hypoxemia in awake animals. In the presence of volatile anesthetics, coronary blood flow decreased, a decrease that was unchanged with hypoxemia. Thus, there was a large difference in brain and coronary blood flows between awake hypoxemic and anesthetized hypoxemic animals. Hypoxemia did not alter the magnitude of renal, gastrointestinal tract, or total hepatic blood flows in awake animals. However, all three blood flows decreased significantly in anesthetized hypoxemic animals. We conclude that volatile anesthetics modify the compensatory responses to hypoxemia that occur in awake animals, resulting in decreased blood flow to vital organs.

Volatile Anesthetic Effects on Left Ventricular Relaxation in Swine

The effects of halothane (0.5, 1.0, and 1.5%; n = 10), enflurane (1.0, 2.0, and 3.0%; n = 8), and isoflurane (0.75, 1.5, and 2.25%; n = 8) on isovolumic relaxation were studied in open-chest swine. The time constant for isovolumic left ventricular pressure decline, T, was determined at each anesthetic concentration at the intrinsic heart rate and during atrial pacing to 150 beats per min. The effect of increased left ventricular afterload on T was investigated by partial occlusion of the thoracic aorta to raise the left ventricular systolic pressure to baseline in the presence of volatile anesthetics, and 20% above baseline in the absence of volatile anesthetics. Heart rate and left ventricular systolic pressure decreased substantially with all three anesthetics, whereas left ventricular end-diastolic pressure increased (by 3-4 mmHg). Relaxation time constants increased with all three anesthetics at the intrinsic heart rate; when the heart rate was controlled by pacing, T increased in the halothane and enflurane, but not in the isoflurane, experiments. T was significantly prolonged (by 30-100%) by partial aortic occlusion in the presence of anesthetic, but not in the control measurements. T did not change significantly in the isoflurane experiments when atrial pacing was employed with partial aortic occlusion. The volatile anesthetics, particularly halothane, seem to impair the relaxation process of the left ventricle; further investigation of the mechanisms of this interference, such as anesthetic effects on intracellular calcium movement and total left ventricular load, is warranted.

The effect of volatile anesthetics on the pH dependence of calcium uptake by cardiac sarcoplasmic reticulum.

The effect of volatile anesthetics (VA) on the pH dependence of calcium uptake by cardiac sarcoplasmic reticulum (SR) was studied. SR was incubated at 37 degrees C with 45CaCl2 in the control state (no anesthetic) and in the presence of each of the VA from pH 6.6-7.6. The VA used were: halothane, 1.3%; enflurane, 1.8%; and isoflurane, 1.2%. In the control state, the initial rate of calcium uptake, measured after a 2-min incubation, was maximal at pH 6.8 (mean +/- SEM: 665 +/- 37 nmoles/mg) and markedly inhibited at pH 7.6 (107 +/- 9 nmoles/mg). In the presence of the VA, the calcium uptake rate was mildly depressed (7-32%) at pH 6.6-6.8, unchanged at pH 7.0, and greatly enhanced (52-78%) at pH 7.2-7.6, when compared to control. The maximal uptake of calcium by the SR at a calcium concentration of 10(-6)M, measured by a 20-min incubation, had a similar pH dependence in the control state, with a decline first evident at pH 7.2 and a 50% drop in the maximal uptake of calcium from pH 7.0-7.6. The presence of the VA was associated with a uniform depression of the maximal uptake of calcium by the SR at all pH levels measured. In view of these findings, it appears that pH does affect SR function in the presence of VA. This alteration of the pH effect by VA may be a factor responsible for discrepancies in results previously reported by investigators studying the effects of VA on the uptake of calcium by the SR.

An evaluation of IL-404 oxygen alarm monitor.

The accuracy of the IL404 oxygen alarm monitor has been tested against oxygen/nitrogen mixtures of known composition. The effects of inhalational anaesthetic agents and of changes in flow rate, PCO2 and humidity have also been investigated. The instrument was found to be sufficiently stable and accurate for clinical use and was unaffected by the presence of volatile anaesthetics, change in gas flow rate and the presence of nitrous oxide, carbon dioxide or water vapour. The instrument incorporates an efficient alarm system which gives both audible and visible warning should the oxygen concentration fall or exceed pre-set limits.