Sevoflurane Inhalation Research Articles

Protective effects of Coenzyme Q10 against sevoflurane-induced cognitive impairment through regulating apolipoprotein E and phosphorylated Tau expression in young mice.

Children with multiple exposures to anesthesia and surgery may be more likely to develop the learning disability. Coenzyme Q10 (CoQ10) was reported to reduce the multiple sevoflurane treatment-induced cognitive deficiency in 6-day-old young mice. However, its specific mechanisms have not yet been found. This research aimed to reveal the role of ApoE in the pathogenesis of cognitive deficiency caused by sevoflurane anesthesia and the protective mechanism of CoQ10 in a multiple sevoflurane treatment model of young mice. The mice were randomly divided into four groups: Control+corn oil, Sevoflurane+corn oil, Control+CoQ10, and Sevoflurane+CoQ10. Sevoflurane group mice were anesthetized with 3% sevoflurane and 60% oxygen 2hr a day for 3days, while control group mice received only 60% oxygen. Mice received an intraperitoneal injection of 50mg/kg CoQ10 or the same volume of corn oil 30min before the inhalation of oxygen or sevoflurane for 3days. Mice received sevoflurane anesthesia or control treatment from the 6th to 8th day after birth. The cortex and hippocampus were harvested on the 8th day. The ATP, MMP, ApoE mRNA, total ApoE, ApoE fragments, Aβ1-40, Aβ1-42, Tau5, AT8, and PHF levels were detected. The Morris water maze (MWM) tests were performed from P30 to p36 after anesthesia or control treatment. The results indicated that the injection of CoQ10 ahead of sevoflurane treatment could reverse the anesthesia-induced energy deficiency, mitochondrial dysfunction, ApoE, and its fragments expression, Aβ1-42 generation, Tau phosphorylation, and cognitive impairment in young mice. These data reveal that the ApoE and its fragments enhancement may play an important role in the pathogenesis of cognitive deficiency caused by sevoflurane anesthesia. CoQ10 could reduce ApoE expression by improving energy replenishment and mitochondrial functions, thereby alleviating sevoflurane-induced brain damage and cognitive impairment.

Sevoflurane versus ketamine+diazepam anesthesia for assessing systemic and hepatic hemodynamics in rats with non-cirrhotic portal hypertension.

The selection of the anesthetic regime is a crucial component in many experimental animal studies. In rodent models of liver disease, the combination of ketamine and diazepam (KD), generally by the intramuscular (i.m.) route, has traditionally been the anesthesia of choice for the evaluation of systemic and hepatic hemodynamics but it presents several problems. Here, we compared the performance of inhalational sevoflurane (Sevo) against the KD combination as the anesthesia used for hemodynamic studies involving the measurement of portal pressure in normal rats (Ctrl) and rats with non-cirrhotic portal hypertension induced by partial portal vein ligation (PPVL). Compared with Ctrl rats, rats with PPVL presented characteristic alterations that were not influenced by the anesthetic regime, which included liver atrophy, splenomegaly, increased plasma fibrinogen, decreased alkaline phosphatase and glycemia, and frequent ascites. The use of the KD combination presented several disadvantages compared with the inhalational anesthesia with sevoflurane, including considerable mortality, a higher need of dose adjustments to maintain an optimal depth of anesthesia, increases of heart rate, and alteration of blood biochemical parameters such as the concentration of aspartate aminotransferase, lactate, and lactic dehydrogenase. Rats anesthetized with sevoflurane, on the other hand, presented lower respiratory rates. Importantly, the anesthetic regime did not influence the measurement of portal pressure either in Ctrl or PPVL rats, with the increase of portal pressure being similar in Sevo- and KD- anesthetized groups of PPVL rats compared with their respective control groups. Overall, our results suggest that anesthesia with sevoflurane is preferable to the combination of KD for performing systemic and hepatic hemodynamic studies in rats with non-cirrhotic portal hypertension.

CURRENT POSSIBILITIES OF USE OF INDIRECT CALORIMETRY IN PERIOPERATIVE ENERGY MONITORING

The purpose of the study is to develop a method of perioperative energy monitoring and to implement it in clinical practice.
 Material and methods. The study involved 125 patients who underwent various surgical interventions under general anesthesia using sevoflurane (inhalation anesthetics) and fentanyl (narcotic analgesics) in low-flow artificial lung ventilation. Methods of perioperative monitoring (International Standards for a Safe Practice of Anesthesia 2010, WFSA) were supplemented using indirect calorimetry.
 Results. Analyzing the literature data, a close correlation was found between the energy equivalent of oxygen (EEE2) and the respiratory factor (RQ). The authors obtained the corresponding one-factor linear regression formula, which had the form: EEE2 = 1.157 × RQ + 4,037. Using the basic principles of gas exchange in the lungs of Bohr-Engoff, a method of perioperative energy monitoring was developed, based on indirect calorimetry, taking into account the real values ​​of the energy equivalent of patients' oxygen. The universal formula for determining the level of metabolism of the patient (MR, cal / min) in the form of:
 MR = [0,863 × VE × (PECO2 / PaCO2) × (FiO2 - FeO2)] (1,157 × RQ + 4,037)
 where, VE - total ventilation of the lungs per minute (ml / min), PECO2, PaCO2 - partial pressure, respectively, in a mixture of gases, which is exhaled and in the arterial blood (mm Hg). FiO2 and FEO2 are the oxygen fraction in the gas mixture that is inhaled and exhaled in units (% / 100). The method is implemented as a computer program created on the basis of the developed formula. The methods of intensive perioperative therapy taking into account the level of metabolism are presented.
 Conclusion. The method of perioperative energy monitoring substantially complements the "International Standards for Safe Anesthesiology Practice", WFSA (2010) enhances the perioperative safety of patients by detecting metabolic disorders and conducting appropriate pathogenetic correction.

Sevoflurane versus PRopofol combined with Remifentanil anesthesia Impact on postoperative Neurologic function in supratentorial Gliomas (SPRING): protocol for a randomized controlled trial

BackgroundPatients with intracranial tumors are more sensitive to anesthetics than the general population and are therefore more susceptible to postoperative neurologic and neurocognitive dysfunction. Sevoflurane or propofol combined with remifentanil are widely used general anesthetic regimens for craniotomy, with neither regimen shown to be superior to the other in terms of neuroprotective efficacy and anesthesia quality. There is no evidence regarding the variable effects on postoperative neurologic and neurocognitive functional outcome under these two general anesthetic regimens. This trial will compare inhalational sevoflurane or intravenous propofol combined with remifentanil anesthesia in patients with supratentorial gliomas and test the hypothesis that postoperative neurologic function is equally affected between the two regimens.MethodsThis is a prospective, single-center, randomized parallel arm equivalent clinical trial, which is approved by China Ethics Committee of Registering Clinical Trials (ChiECRCT-20,160,051). Patients with supratentorial gliomas diagnosed by magnetic resonance imaging will be eligible for the trial. Written informed consent will be obtained before randomly assigning each subject to either the sevoflurane-remifentanil or propofol-remifentanil group for anesthesia maintenance to achieve an equal-desired depth of anesthesia. Intraoperative intervention and monitoring will follow a standard anesthetic management protocol. All of the physiological parameters and other medications administered during the intervention will be recorded. The primary outcome will be neurologic function change assessed by National Institute of Health Stroke Scale (NIHSS) within 4 h after general anesthesia when observer’s assessment of alertness/sedation (OAA/S) reaches 4. Secondary outcomes will include NIHSS and modified NIHSS change 1 and 2 days after general anesthesia, hemodynamic stability, intraoperative brain relaxation, quality of anesthesia emergence, quality of anesthesia recovery, postoperative cognitive function, postoperative pain, postoperative neurologic complications, as well as perioperative medical expense.DiscussionThis randomized equivalency trial will primarily compare the impacts of sevoflurane-remifentanil and propofol-remifentanil anesthesia on short-term postoperative neurologic function in patients with supratentorial gliomas undergoing craniotomy. The exclusion criteria are strict to ensure that the groups are comparable in all aspects. Repeated and routine neurologic evaluations after operation are always important to evaluate neurosurgical patients’ recovery and any newly presenting complications. The results of this trial would help specifically to interpret anesthetic residual effects on postoperative outcomes, and perhaps would help the anesthesiologist to select the optimal anesthetic regimen to minimize its impact on neurologic function in this specific patient population.Trial registrationThe study was registered and approved by the Chinese Clinical Trial Registry (Chinese Clinical Trial Registry, ChiCTR-IOR-16009177). Principle investigator: Nan Lin (email address: linnan127@gmail.com) and Ruquan Han (email address: hanrq666@aliyun.com) Date of Registration: September 8th, 2016. Country of recruitment: China.

Forkhead Box O1-p21 Mediates Macrophage Polarization in Postoperative Cognitive Dysfunction Induced by Sevoflurane.

The current study was conducted in order to investigate the role of Forkhead box O1 and p21-mediated macrophage polarization in postoperative cognitive dysfunction induced by sevoflurane. There involved a total of 30 healthy mice that were randomly divided into two groups: control group (without any treatment) and anaesthesia group (treated with sevoflurane inhalation). The effects of sevoflurane on cognitive function (memory) in mice were studied by trace fear conditioned reflex, and the effects of systemic inflammation and behavior after operation were measured by enzyme-linked immunosorbent assay (ELISA), the concentrations of CD163 and tumor necrosis factor-α (TNF-α) were measured. The expression of macrophage phenotype was observed by immunofluorescence staining, the expression levels of M1 and M2 markers mRNA were detected by real-time fluorescence quantitative PCR (RT-PCR), and the expression levels of FoxO1 and p21 were analyzed by immunoblotting (Western blot). Compared with the control group, the freezing time in the anesthesia group was lower than that in the control group (P<0.01), indicating that sevoflurane anesthesia led to the decrease of cognitive ability. The blood concentrations of CD163 and TNF-α increased significantly at 24 h after the operation with sevoflurane anesthesia (P<0.05). Fluorescence microscopic observation showed that M2 was the main type of macrophages in normal tissues, while M1 and M2 phenotypes were highly expressed in sevoflurane anesthetized tissues at the same time, especially in M1 phenotypes (P<0.01). The polarization of macrophages in the anesthetic group showed the high level of M1 mRNA, and the expression levels of TNF-α, monocyte chemotactic protein 1(MCP-1) and Interleukin-6 (IL-6)mRNA in the anesthetic group were significantly higher than those in the control group (P<0.05). The expression levels of M2 mRNA such as transforming growth factor-β (TGF-β) and IL-10 were significantly lower than those in the control group (P<0.05). Compared with the control group, the expression of FoxO1 and p21 protein in the anesthesia group was significantly lower than that in the control group with a significant statistical difference (P<0.01). This study offers a theoretical basis and insight for further understanding of the prevention and treatment of cognitive dysfunction induced by anesthetic drugs.

Resting state networks of the canine brain under sevoflurane anaesthesia.

Resting-state functional Magnetic Resonance Imaging (rs-fMRI) has become an established technique in humans and reliably determines several resting state networks (RSNs) simultaneously. Limited data exist about RSN in dogs. The aim of this study was to investigate the RSNs in 10 healthy beagle dogs using a 3 tesla MRI scanner and subsequently perform group-level independent component analysis (ICA) to identify functionally connected brain networks. Rs-fMRI sequences were performed under steady state sevoflurane inhalation anaesthesia. Anaesthetic depth was titrated to the minimum level needed for immobilisation and mechanical ventilation of the patient. This required a sevoflurane MAC between 0.8 to 1.2. Group-level ICA dimensionality of 20 components revealed distributed sensory, motor and higher-order networks in the dogs’ brain. We identified in total 7 RSNs (default mode, primary and higher order visual, auditory, two putative motor-somatosensory and one putative somatosensory), which are common to other mammals including humans. Identified RSN are remarkably similar to those identified in awake dogs. This study proves the feasibility of rs-fMRI in anesthetized dogs and describes several RSNs, which may set the basis for investigating pathophysiological characteristics of various canine brain diseases.

Hemodynamic Stability, Patient Acceptance and Cost of Intravenous Propofol and Inhalational Sevoflurane for Induction of Anaesthesia: A Prospective, Randomized Comparative Study.

IntroductionThe effects of an anesthetic agent on the hemodynamic stability are of prime importance in patients with compromised hemodynamics. Although comparative studies of sevoflurane and propofol are reported, most of these are aimed to assess maintenance and early postoperative recovery. There are very few studies on hemodynamic changes occurring with these two agents. This study compares the hemodynamic stability, patient acceptance, and cost of intravenous (IV) propofol versus inhalational (IH) sevoflurane for the induction of anesthesia.MethodsThis prospective, randomized comparative study was conducted among 80 patients with American Society of Anaesthesiologists (ASA) grade-I requiring general anesthesia (GA) for elective surgical procedures. The study was approved by the institutional ethics committee and was conducted as per the principles of the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Enrolled patients were randomized to receive either intravenous (IV) propofol 2 mg/kg (n=40) or gradual inhalational (IH) induction with sevoflurane (n=40). All patients were maintained with sevoflurane 2% in 67% nitrous oxide (N2O) and O2. Hemodynamic parameters like pulse rate and mean arterial pressure (MAP) were monitored every minute up to five minutes. Patients' acceptance was assessed on a 10-item questionnaire, and the cost of anesthesia was assessed based on the anesthetic requirement. The hemodynamic parameters were compared between the two groups using two-way repeat-measures ANOVA. The incidence of hypotension was compared using Fischer’s test. ResultsThe two groups were similar at baseline with respect to the demography and other baseline characteristics. There was greater (p<0.05) fall in MAP with propofol induction (28.48%) compared to sevoflurane (14.61%). Greater reduction in pulse rate (p<0.05) with sevoflurane (9.18) induction was observed compared to propofol (5.28). Patient acceptance for both drugs was similar (p>0.05). Although sevoflurane was unpleasant, propofol injection was painful. Ninety percent of patients preferred propofol for repeat anesthesia as against 85% of patients with sevoflurane. Considering the quantity of anesthetic consumed and the unit cost, propofol was more costly as compared to sevoflurane.ConclusionSevoflurane maintains better hemodynamic stability compared to propofol, and patient acceptance of both drugs is similar. Induction with sevoflurane was found to be cheaper as compared to propofol induction.

Effects of hippocampal Na+-K+-2C1- cotransporter on sevoflurane-induced neurobehavioral impairments in neonatal rats

Objective To discuss the effects of hippocampal Na+-K+ -2C1- cotransporter (NKCC1) on sevoflurane-induced neurobehavioral impairments in neonatal rats. Methods Thirty six 6-day-old male Sprague-Dawley rats were divided into three groups (n=12), according to the random number table method: a control group (group C), a sevoflurane group (group S), and a sevoflurane + bumetanide group (group SB). Group C inhaled 30% oxygen for 6 h, while groups S and SB inhaled 2.1% sevoflurane+30% oxygen for 6 h. Group SB was intraperitoneally injected with bumetanide (1.82 mg/kg) 15 min before sevoflurane inhalation. Then, 4 weeks later, the elevated plus maze and prepulse inhibition (PPI) tests were performed. One week after behavior tests, the hippocampus was harvested. Quantitative real time PCR and Western blot were used to detect the levels of NKCC1 mRNA and protein. Results In the elevated plus maze test, no significant difference was observed in total movement distance among the three groups (P<0.05). Compared with group C, group S spent shortened time of stay in the open arms, presented decreased PPI% corresponding to PP3 and PP6 (P<0.05), and produced increased amounts of hippocampal NKCC1 mRNA and protein (P<0.05). Compared with group S, group SB presented extended time in the open arms, increased PPI% corresponding to PP3 and PP6, and declined amounts of hippocampal NKCC1 mRNA and protein (P<0.05). Conclusions Sevoflurane may cause neurobehavioral damages in neonatal rats, which may be associated with NKCC1. Key words: Sevoflurane; Na+-K+ -2C1- cotransporter; Hippocampus; Neuroethology; Neonatal rats

HSP90 inhibitor 17AAG attenuates sevoflurane-induced neurotoxicity in rats and human neuroglioma cells via induction of HSP70

Background17AAG has been extensively studied for its antitumor effects that protect cells from lethal stress by maintaining protein stability. The role of 17AAG in sevoflurane-induced neuronal injury has never been studied. We aim to investigate the effect of 17AAG on sevoflurane-induced neurotoxicity in vivo and in vitro.MethodsSevoflurane-induced hippocampal neuron injury model was established in aged Sprague–Dawley rats. Pretreatment of vehicle or 17AAG was administered prior to sevoflurane inhalation. H4 neuroglioma cells were pretreated with vehicle or 17AAG and exposed to sevoflurane. Apoptosis, oxidative stress, expression of interleukin-6 (IL-6), and activation of the nuclear factor-κB (NF-κB) signaling pathway in H4 cells were examined by Hoechst assay, flow cytometry, Western blot, and immunofluorescent staining. RNA interference against HSPA1A was performed to test the function of HSP70 in neuroprotection.ResultsExogenous 17AAG reduced sevoflurane-induced apoptosis and oxidative stress in rat hippocampal neurons and in H4 cells. In H4 cells, 17AAG suppressed sevoflurane-induced upregulation of IL-6 and activation of NF-κB signaling. 17AAG enhanced sevoflurane-induced upregulation of HSP70 in rat hippocampal neurons and in H4 cells. Conversely, silencing of HSPA1A in H4 cells blocked the cytoprotective effect of 17AAG against sevoflurane-induced apoptosis and oxidative stress, and prevented upregulation of IL-6 and activation of NF-κB signaling.Conclusions17AAG protects against sevoflurane-induced neurotoxicity in vivo and in vitro via HSP70-dependent inhibition of apoptosis, oxidative stress, and pro-inflammatory signaling pathway.

Iron overload contributes to general anaesthesia-induced neurotoxicity and cognitive deficits

BackgroundIncreasing evidence suggests that multiple or long-time exposure to general anaesthesia (GA) could be detrimental to cognitive development in young subjects and might also contribute to accelerated neurodegeneration in the elderly. Iron is essential for normal neuronal function, and excess iron in the brain is implicated in several neurodegenerative diseases. However, the role of iron in GA-induced neurotoxicity and cognitive deficits remains elusive.MethodsWe used the primary hippocampal neurons and rodents including young rats and aged mice to examine whether GA impacted iron metabolism and whether the impact contributed to neuronal outcomes. In addition, a pharmacological suppression of iron metabolism was performed to explore the molecular mechanism underlying GA-mediated iron overload in the brain.ResultsOur results demonstrated that GA, induced by intravenous ketamine or inhalational sevoflurane, disturbed iron homeostasis and caused iron overload in both in vitro hippocampal neuron culture and in vivo hippocampus. Interestingly, ketamine- or sevoflurane-induced cognitive deficits, very likely, resulted from a novel iron-dependent regulated cell death, ferroptosis. Notably, iron chelator deferiprone attenuated the GA-induced mitochondrial dysfunction, ferroptosis, and further cognitive deficits. Moreover, we found that GA-induced iron overload was activated by NMDAR-RASD1 signalling via DMT1 action in the brain.ConclusionWe conclude that disturbed iron metabolism may be involved in the pathogenesis of GA-induced neurotoxicity and cognitive deficits. Our study provides new vision for consideration in GA-associated neurological disorders.

Use of medetomidine, midazolam, ketamine and sevoflurane as an anesthetic protocol for domestic chickens

Changes in physiological and biochemical parameters after administration of medetomidine (MED), midazolam (MID), ketamine (KET) and a 2% of the inhalation anesthetic sevoflurane (SEVO), were investigated in domestic chickens. The anesthetic protocol began with a simultaneous intrapectoral injection (IP) of MED (50 μg/kg) and MID (0.5 mg/kg), followed by IP administration of 25 mg/kg of KET 10 min later. Anesthesia was then maintained for 30 min by 2% SEVO (with a 500 ml/min oxygen flow), using an Ayres T piece device. Heart and respiratory rates, cloacal temperature, reflex response and electrocardiogram (ECG) parameters were recorded at time cero (T0) before anesthesia (BA, baseline values), at time of MED+MID administration (T1), at time of ketamine injection (T2), 30 min after the start of SEVO inhalation (T3) and at recovery. Blood was also drawn at T0 and T3 to assess albumin, creatinine, glucose and liver enzyme concentrations. Cloacal temperature, heart and respiratory rates differed from baseline values at all time intervals during anesthesia (p&lt;0.05). Heart rate decreased following the MED + MID injection (at T1, T2 and T3), and partially recovered by the reanimation period. Reflex response also differed between time 0 and all anesthesia time points (p&lt;0.05). Mean amplitude of the P wave of the ECG was increased during MED + MID (T1) and KET (T2) anesthesia. The mean ST interval showed a large increase at T1, which was maintained throughout anesthesia (p &lt;0.05). Albumin, glucose and the ALT enzyme decreased between T0 and T3. In conclusion, the use of MED+MID+KET and SEVO as an anesthetic combination altered cardiorespiratory and biochemical parameters of chickens, but no life-threatening effects were observed as a result of these changes. Hence, this drug combination can be adequately used as an anesthesia protocol in chickens.

Anesthesia and Anesthetic-Related Complications of 8 Elegant-Crested Tinamous (Eudromia elegans) Undergoing Experimental Surgery.

The aim of this study was to describe the anesthetic effects of an injectable anesthetic protocol, based on ketamine, midazolam, and medetomidine, followed by inhalational sevoflurane, in 8 elegant-crested tinamous (Eudromia elegans) undergoing experimental surgery. Initial doses for both injectable agents were tested in 1 bird and then refined with an algorithm based on the effects observed in the pilot procedure. Heart and respiratory rates, as well as nociceptive reflexes, were evaluated before anesthesia (baseline) and intraoperatively, at 10 minute intervals. The time from injection to anesthetic induction and surgical anesthesia, as well as the time from atipamezole injection to recovery, was recorded for each bird. The median doses of medetomidine and ketamine were 0.075 mg/kg and 33 mg/kg, respectively. Anesthetic induction was achieved within 10 (range, 4-45) minutes from intramuscular injection, whereas time to surgical anesthesia was 22 ±16 minutes. The baseline heart rate values were significantly higher than those measured intraoperatively at any time point (P = .001). Intraoperatively, 5 of 8 tinamous (63%) developed cardiac arrhythmias. Other encountered complications were regurgitation in 2 birds (25%), cardiac arrest in 1 bird (13%) soon after injection of the anesthetic agents, and prolonged recovery in another bird (13%), which was euthanized. Necropsy of the 2 fatal outcomes (25%) showed evidence of hepatic lipidosis in both (100%) and intramyocardial fat accumulation in 1 bird (50%). This report highlights the challenges of tinamou anesthesia. Cardiac complications are common in this species, and close monitoring of intraoperative cardiovascular variables is recommended for prompt recognition and treatment.

A comparison between Sevoflurane Volatile Induction/Maintenance Anesthesia and Propofol Total Intra-venous Anesthesia for Rigid Bronchoscopy under Spontaneous Breathing for Tracheal/Bronchial Foreign Body Removal in Children

Abstract Background Foreign body aspiration is a life-threatening condition. Asphyxiation from inhaled foreign bodies is a leading cause of accidental death among children younger than 4 years. While early clinicians used topical anesthesia, general anesthesia became common place for the removal of aspirated objects with increased experience with the rigid bronchoscope and advances in anesthetic delivery. Inhaled anesthesia and total intravenous anesthesia are widely used for rigid bronchoscopy in children. Objective In this study, we compared sevoflurane VIMA and propofol TIVA, when used for both induction and maintenance of anesthesia in children undergoing rigid bronchoscopy for tracheal or bronchial foreign body removal. Methods This is a prospective double – blinded, randomized controlled Trial, After Approval is obtained from the research ethics committee of anaesthesia and intensive care department, Ain Shams University. Patients were randomly divided into two groups (n = 30 each). In Group VIMA, anesthesia was induced with inhalation of sevoflurane. Before induction, a closed circuit with a 1-l reservoir bag was overflowed by 8 vol % sevoflurane with 0.3 l/min fresh oxygen flow for 3 min. In Group TIVA, a bolus of 2.5 mg/kg propofol was administered over 30 seconds. Additional propofol 0.5–1 mg/kg was given as needed to deepen anesthesia. Results Our results demonstrate that compared with propofol TIVA, sevoflurane VIMA provides more stable haemo-dynamics and respiration, faster induction and recovery and higher incidence of excitement in paediatric patients undergoing tracheal/bronchial foreign body removal. Conclusion Foreign body aspiration is a life-threatening condition. Anesthetic management can be challenging, as the airway is shared with the surgeon and adequate ventilation must be maintained despite airway manipulation.

General anesthesia technique and perception of quality of postoperative recovery in women undergoing cholecystectomy: A randomized, double-blinded clinical trial.

BackgroundThe two most common general anesthesia techniques are total intravenous anesthesia (TIVA) and venous/inhalation balanced general anesthesia (BGA). It is unclear whether any of these two techniques affect patient perception of the quality of recovery. The aim of this randomized, double-blinded clinical trial was to assess the quality of postoperative recovery of women undergoing laparoscopic cholecystectomy under general anesthesia. We compared patients who received TIVA with those who received BGA. We also evaluated the factors that may decrease patient-perceived quality of postoperative recovery.MethodsWe prospectively recruited 121 women aged 18–65 years who were scheduled for elective laparoscopic cholecystectomy due to cholelithiasis. These patients were randomized to receive TIVA (target-controlled infusion of propofol and remifentanil) or BGA (continuous remifentanil infusion and sevoflurane inhalation). To measure the quality of postanesthetic and postoperative recovery, we administered the Quality of Recovery-40 (QoR-40) questionnaire 24 hours after the patient awoke from anesthesia.ResultsAll 60 patients in the TIVA group responded to QoR-40 (median, 188 points; minimum 128; maximum 200). Sixty-one patients in the BGA group had a mean QoR-40 score of 186 points (median, 188 points; minimum 146; maximum 200). There was no significant difference in the QoR-40 score between the two groups (p = 0.577). The patients who presented postoperative nausea and vomiting (PONV) and pain had worse perception of the quality of postoperative recovery.ConclusionsBoth TIVA and BGA had a similar effect on the perception of the quality of postoperative recovery in women undergoing elective laparoscopic cholecystectomy. PONV and pain may negatively affect patient perception of the quality of postoperative recovery.

Effects of inhalation of sevoflurane at different concentrations on TRPV1 in airways of rats at different developmental stages

AimDetermine changes in the expressions of the ion channel—TRPV1—and neuropeptides—NKA, NKB, calcitonin gene-related peptide (CGRP), and SP—in 14-, 21-, and 42-day-old rats after inhaling 1.5% and 2.6% sevoflurane. Main methodsA small in-house inhalation anesthesia chamber was designed to allow 14-, 21-, and 42-day-old rats inhale 1.5% and 2.6% sevoflurane, and rats in the control group inhaled carrier gas(1 L/min air +1 L/min O2). In addition, 14- and 21-day-old rats were pretreated with capsazepine, followed by inhalation of 1.5% and 2.6% sevoflurane or the carrier gas. The expression of TRPV1 in lung tissues was detected by Western blotting, whereas the expressions of NKA, NKB, CGRP, and SP in the trachea were detected by immunohistochemistry. Key findingsAfter inhalation of 1.5% sevoflurane, the expression of TRPV1 in the lung tissues of 14- and 21-day-old rats was significantly increased compared with that in the control group, which was antagonized by capsazepine pretreatment. Moreover, inhalation of 1.5% sevoflurane markedly increased the expressions of NKA, NKB, CGRP, and SP in the trachea of 21-day-old rats and of NKB, CGRP, and SP in the trachea of 14-day-old rats. The expressions of these molecules were antagonized by capsazepine pretreatment. Conversely, inhalation of 2.6% sevoflurane decreased the expressions of NKA and NKB in the trachea of 42-day-old rats. SignificanceSevoflurane did not upregulate the expression of TRPV1 in the airways of late-developing rats. This anesthetic may have a two-way effect on airways, resulting in considerable effects in pediatric clinical anesthesia management.

Sevoflurane anesthesia-mediated oxidative stress and cognitive impairment in hippocampal neurons of old rats can be ameliorated by expression of brain derived neurotrophic factor

Postoperative cognitive dysfunction in elderly patients has been related to neurodegenerative disorders and mortality. Sevoflurane anesthesia has been implicated in both postoperative cognitive dysfunction and neurotoxicity. Given the advantages of using inhaled anesthetics like sevoflurane, it is important to understand how their usage results in neurotoxicity and subsequently devise ways to circumvent or attenuate the anesthetic-mediated induction in neurotoxicity. We have used an aged rat model to investigate the molecular mechanisms by which sevoflurane inhalation results in neurotoxicity and whether modulation of these molecular mechanisms can inhibit or attenuate neurotoxicity and cognitive learning and memory impairment in these animals. Low- or high-dose of sevoflurane resulted in reactive oxygen species generation, increased NADPH oxidase protein expression, apoptosis and autophagy. Sevoflurane inhalation resulted in significant inhibition of brain derived neurotrophic factor (BDNF) and cognitive impairment. And the activation of PI3K/Akt/mTOR signaling pathways are attenuated in sevoflurane-mediated anesthesia. Adeno-associated virus (AAV)-mediated expression of Bdnf, but not controls EGFP, attenuated sevoflurane-induced oxidative stress and cognitive impairment in the rats. Our results highlight that AAV-mediated gene therapy might offer a potential therapeutic opportunity to treat post-operative cognitive impairment resulting from inhaled anesthetics.

Methylene Blue Protects Against Sevoflurane-Induced Cognitive Dysfunction by Suppressing Drp1 deSUMOylation in Aged Mice.

Exposure to sevoflurane and other inhalational anesthetics can induce cognitive impairment in elderly patients. Studies have indicated that methylene blue (MB) has beneficial effects on multiple neurodegenerative diseases and the mechanism involves mitochondrial function preservation. However, whether MB can attenuate the cognitive decline induced by sevoflurane in aged mice requires further investigation. Forty-five 18-month-old C57/BL mice were used to establish a model of sevoflurane-induced cognitive impairment in which the mice were exposed to 3% sevoflurane for 2h. Mice in the MB group were intraperitoneally injected with MB at a dose of 5mg/kg before sevoflurane inhalation. The Morris water maze test was used to evaluate the learning and memory performances. We also examined changes in mitochondrial morphology as well as the expression and interaction of related proteins in the aged hippocampus. Parkin, BCL2/adenovirus E1B 19kDa protein-interacting protein 3 (BNIP3), mitochondrial dynamin-related protein 1 (Drp1), small ubiquitin-like modifier (SUMO2/3), SUMO-specific proteases 3 (SENP3), and ubiquitin-like conjugating enzyme 9 expression in the mouse hippocampus was detected by western blotting, and SUMO2/3-Drp1 was examined by coimmunoprecipitation. Exposure to sevoflurane increased SENP3 expression and Drp1 deSUMOylation in the aged hippocampus and resulted in cognitive deficiency. MB attenuated sevoflurane-induced memory loss and mitochondrial fragmentation and decreased Drp1 deSUMOylation in the aged hippocampus. This neuroprotective effect provides a mechanistic explanation for how the SUMOylation status of Drp1 acts as a key switch in the cognitive dysfunction induced by sevoflurane.

Effects of general anesthesia of sevoflurane inhalation on perioperative blood gas indicators in patients with mild-to-moderate chronic obstructive pulmonary disease

Objective To explore the clinical effects of general anesthesia of sevoflurane inhalation in abdominal surgery for patients with mild-to-moderate chronic obstructive pulmonary disease (COPD). Methods The clinical data of 68 patients with COPD abdominal surgery who admitted to the Department of Anesthesiology of Yiwu Central Hospital from June 2016 to June 2018 were retrospectively analyzed.According to the ratio of forced expiratory volume in 1 second in predicted value (FEV1%pre), the patients were divided into mild group (FEV1%pre≥80%, n=39) and moderate group (80%>FEV1%pre≥50%, n=29). The blood gas indicators[arterial partial pressure of oxygen (PaO2), arterial partial pressure of blood carbon dioxide (PaCO2), blood oxygen saturation (SaO2)], vital signs[heart rate (HR), mean arterial pressure (MAP)] and systemic vascular resistance (SVR) were compared between the two groups after entering (T0), after completion of induction (T1), at abdominal exploration (T2), before the end of surgery (T3) and after extubation (T4). The recovery quality indicators were analyzed in the two groups. Results In the mild group at T1, T2 and T3, the PaO2 values were (301.6±76.2)mmHg, (292.6±73.4)mmHg, (112.8±34.1)mmHg, respectively, and the SaO2 values were (99.1±0.8)%, (98.8±1.0)%, (94.5±2.2)%, respectively, all of which were significantly improved compared with those at T0 (t=23.51, 22.73, 12.34, 2.75, 2.93, 2.22, all P 0.05). At T4, the PaO2, PaCO2 and SaO2 levels in the two groups showed no significant changes compared with those at T0, and there was no statistically significant difference between the two groups at the same time (all P>0.05). At T1 and T2, the MAP levels in the mild group were (75.5±11.0)mmHg, (80.7±11.9)mmHg, respectively, the HR values were (71.4±12.5)times/min, (74.2±13.6)times/min, respectively, the SVR values were (9.1±1.6)×102 dynesos-1ocm-5, (9.9±2.0) ×102 dynesos-1ocm-5, which were significantly lower than those at T0 (t=1.35, 0.95, 1.83, 0.64, 1.42, 0.27, all P 0.05). At T3 and T4, there were no significant changes in levels of MAP, HR and SVR between the two groups compared with those at T0, and there were no significant significant differences between the two groups (all P>0.05). The spontaneous breathing time, duration of eye opening, time of fist, time of removing tracheal catheter and time of returning to the ward in the mild group were slightly shorter than those in the moderate group (all P>0.05). Conclusion When general anesthesia of sevoflurane inhalation is used in abdominal surgery of COPD patients, the trend of blood gas indicators is not affected by COPD, which can provide reference for clinical establishment of anesthesia regimens. Key words: Sevoflurane; Anesthesia, general; Pulmonary disease, chronic obstructive; Abdominal surgery; Blood gas indexes; Expiratory volume; Vital signs; Recovery quality index

A Comparative Study on Postoperative Complications in Using Total Intravenous Anesthesia with Propofol and Sevoflurane Inhalation Anesthesia

A Comparative Study on Postoperative Complications in Using Total Intravenous Anesthesia with Propofol and Sevoflurane Inhalation Anesthesia

Unintentional brainstem anesthesia after prolonged sub-tenon block. Сase report

A 64-year-old ASA 2 woman, with left eye retinal detachment was admitted for pars plana vitrectomy. There were no any neurological diseases, stroke, angina, myocardial infarction, epilepsy and allergy in her medical history. There aren’t clinical significant changes in her blood tests and ECG. General anesthesia was induced and maintained with inhalation of sevoflurane on target value of MAC 0.9–1.1. Analgesia was maintained by prolonged Sub-Tenon block — 1 % lidocaine 2 ml/h through catheter. The duration of surgery was 215 minutes. Sevoflurane and lidocaine were stopped immediately after the end of the surgery. The effective spontaneous breath has been noted by the first minute after surgery. However, the delayed recovery wasn’t allowing to discharge the patient from operating room within 50 minutes and the drowsiness was persisted 1.5 hours more after this. There wasn’t any neurological deficiency, the hemodynamic was stable and the patient had an effective breath during this time and later in postoperative period. With the exception of a possibility of inadvertent intravenous introduction of local anesthetic and development of systemic toxicity, the most probable cause of this complication was the brainstem anesthesia. The possibility of brainstem anesthesia in ophthalmology is well described when using retrobulbar and peribulbar anesthesia. The described cases of this complication of Sub-Tenon block are single. Our case presented a serious adverse event of prolonged Sub-Tenon block without life treating symptoms and neurologic consequences.