Effects of Sevoflurane at Different Concentrations on ApoE in Hippocampus of Aged Rats With Hypercholesterolemia

Objective: To observe the behavioral changes of aged rats with hypercholesterolemia after inhalation of 1.0 MAC and 1.3MAC sevoflurane , the levels of hippocampal ApoE3, ApoE4 and Aβ1-42, as well as the changes of Aβ1-42 levels of optical density in hippocampal CA3 and CA1 regions, and to investigate the effects of different concentrations of sevoflurane on cognitive function in aged rats with hypercholesterolemia.Method: The 15-month-old male SD rats were fed a high-fat diet for 9 months. Rats successfully modeled (N=54) were randomly divided into three groups:control group (Con group, n=18), low concentration sevoflurane group ( Sev1.0 group, n=18), high concentration sevoflurane group (Sev1.3 group, n=18). Rats in the three groups inhaled aero mixed gas(1L/min O2+1L/min Air), 1.0MAC sevoflurane and 1.3MAC sevoflurane for 2h respectively.1 day, 30 days and 90 days after sevoflurane treatment were defined as T1, T30 and T90 experimental periods, respectively. In the three experiments, 6 rats were randomly selected from Con group, Sev1.0 group and Sev1.3 group to complete the behavior experiment in Morris water maze.Subsequently, the levels of ApoE3, ApoE4 and Aβ1-42 in the left hippocampus were detected by Western Blot.Expression of Aβ1-42 in the right hippocampal CA3 and CA1 regions of rats in each group was detected by frozen immunofluorescence assay.Result: 1. No behavioral changes were found in T1, T30 and T90 experiments.2. At T1 and T30, ApoE4 and Aβ1-42 in Sev1.3 group was significantly different from that in Con group. At T90, there was no difference in the levels of ApoE4 and Aβ1-42 between groups. ApoE3 expression was not statistically significant in the three experimental periods. 3. At T1 and T30, the average optical density of Aβ1-42 in CA3 and CA1 region, Sev1.3 group was significantly different from that in Con group. At T90, there was no significant difference between groups.Conclusion: After inhalation of 1.3MAC sevoflurane in aged SD hypercholesterolemia rats, the levels of ApoE4 and Aβ1-42 were increased in hippocampus at early and middle stage, and the average optical density of Aβ1-42 was increased in CA3 and CA1 area. The change trend of the two ones was consistent, but not enough to cause behavioral changes.

Effects of desflurane and sevoflurane on somatosensory-evoked and motor-evoked potential monitoring during neurosurgery: a randomized controlled trial

Background Better protection can be provided during neurosurgery due to the establishment of somatosensory-evoked potential (SEP) and motor-evoked potential (MEP) monitoring technologies. However, some studies have showed that inhaled halogenated anesthetics have a significant impact on neurophysiological monitoring. Methods A total of 40 consecutive patients undergoing neurosurgery were randomly assigned to two groups receiving inhaled anesthetics, either desflurane or sevoflurane. Multiples levels (concentrations of 0.3, 0.6 and 0.9) of anesthetics were administered at minimum alveolar concentration (MAC), and then the latencies and amplitudes of SEPs and MEPs were recorded. Results SEP and MEP signals were well preserved in patients who underwent neurosurgery under general anesthesia supplemented with desflurane or sevoflurane at concentrations of 0.3, 0.6 and 0.9 MAC. In each desflurane or sevoflurane group, the amplitudes of SEPs and MEPs decreased and the latencies of SEPs were prolonged significantly as the MAC increased (P < 0.05). The SEP latencies of both the upper and lower limbs in the desflurane group were significantly longer, and the SEP amplitudes were significantly lower than those in the sevoflurane group (P < 0.05). The MEP amplitudes in the desflurane group were significantly lower than those in the sevoflurane group (P < 0.05), only the amplitudes of the upper limbs at 0.3 MAC did not vary significantly. Conclusions SEPs and MEPs were inhibited in a dose-dependent manner by both desflurane and sevoflurane. At the same MAC concentration, desflurane appeared to have a stronger inhibitory effect than sevoflurane. All patients studied had normal neurological examination findings, hence, these results may not be applicable to patients with preexisting deficits. Trial registration The study registered on the Chinese Clinical Trial Registry (www.chictr.org.cn), Clinical Trials identifier ChiCTR2100045504 (18/04/2021).

Bleeding Tendency in People Anesthetized with Sevoflurane Vs Isoflurane

Background & Purpose The effects of desflurane and sevoflurane, two commonly used inhalation anesthetics for the maintenance of general anesthesia, on peri- and postoperative bleeding is a focus of interest. This study conductd to evaluating that; Sevoflurane can cause bleeding tendencies more than Isoflurane anesthesia or not? Study design Prospective, randomized comparative study. Setting Ain shams university hospitals. Subjects We included 40 tonsillectomy patients (age from 2 – 12 years old), and classified them according to the anesthetic drug used into 2 independent groups: Isoflurane group (20 patients) and Sevoflurane group (20 patients). Methods All patients were subjected to full history taking, oral cavity examination, anterior rhinoscopy nasal examination, basic laboratory studies for bleeding tendencies (e.g. platelets and INR), adenoidal-tonsillectomy operational data (including operative time calculation), bleeding outcomes (blood loss and packs of blood transfusion) will be recorded, and half of the cases will be anesthetized with sevoflurane and another half with isoflurane. Results In the studied population, the mean age of all patients was (7.1 ± 2.7) years, with (57.5%) of patients were males; while (42.5%) were females. Regarding bleeding outcome data; the average blood loss of all patients was (15.5 ± 3.7) cc, and the average packs used were (4.2 ± 1.1). We found a significant decrease in operative time in the Isoflurane group; compared to the Sevoflurane group (p = 0.0017). Regarding Bleeding outcome data; we found, a significant decrease in blood loss, in the Isoflurane group; compared to the Sevoflurane group (p = 0.00014), and a significant decrease in the number of packs used, in Isoflurane group; compared to Sevoflurane group (p = 0.0018). Conclusion To conclude, anesthesia with isoflurane can lead to a lower amount of intraoperative bleeding compared with sevoflurane. Therefore, isoflurane may be preferred as an inhalational agent for the maintenance of general anesthesia during tonsillectomy and adenoidectomy operations.

Comparison of Effects of Propofol and Sevoflurane Used in Maintenance of General Anaesthesia on Post-Operative Nausea and Vomiting - A Prospective Observational Study

BACKGROUND Post-operative nausea and vomiting is a complication of general anaesthesia but can also be seen less commonly in regional anaesthesia. The uneasiness and discomfort associated with it can make the post-operative period eventful. We conducted this study to evaluate if sevoflurane and propofol used in maintenance of anaesthesia have any influence on post-operative nausea and vomiting. METHODS We included 64 patients in this prospective observational study who were undergoing elective otorhinolaryngology surgery belonging to American Society of Anaesthesiologist (ASA) PS I and II. After induction of general anaesthesia and endotracheal intubation, Group P received propofol at 100 - 200 mcg / kg / hr and group S received sevoflurane as maintenance anaesthetics agent at 1.5 - 2 %. All the patients were given ondansetron intravenously in the intra-operative period. Anaesthetic agents used for maintenance was stopped at the end of the surgery and patients were extubated and shifted to post-operative care unit. Patients were assessed for any occurrence of post-operative nausea and vomiting after extubation for 24 hours. RESULTS There were 2 (6.25 %) patients in the propofol group and 12 (37.5 %) patients in the sevoflurane group who had post-operative nausea and vomiting in the first hour. The difference in the nausea and vomiting between the groups was statistically significant with (P value of 0.0046) higher incidence in sevoflurane group. All the patients who had nausea and vomiting were treated with dexamethasone. When the patients were reassessed after four hours, five patients had nausea in sevoflurane group after four hours, which was treated with metoclopramide or Ondansetron. After six hours, none of the patients had nausea or vomiting. CONCLUSIONS The incidence of post-operative nausea and vomiting was lesser in the propofol group compared to sevoflurane group. KEY WORDS Post-Operative Nausea and Vomiting, Propofol, Sevoflurane, General Anaesthesia

Dynamics of chemiluminescence in the small intestine during anesthetic preconditioning in hemorrhagic hypotension

Введение. Ведущим патогенетическим фактором массивной кровопотери является гипоксия, инициирующая активацию процессов свободнорадикального окисления (СРО) в органах и тканях и системный воспалительный ответ. Показано, что одним из универсальных звеньев формирования множественной органной дисфункции при кровопотере является изменение проницаемости кишечной стенки с транслокацией микрофлоры и токсинов в системный кровоток на фоне реперфузии. В последнее время внимание исследователей привлекает эффект анестетического прекондиционирования, в том числе при операциях, сопровождающихся геморрагической гипотензией (ГГ). Цель исследования - оценка в эксперименте динамики процессов СРО в тонкой кишке при геморрагической гипотензии на фоне применения анестетика севофлурана, обладающего эффектом анестетического прекондиционирования. Методика. Эксперименты проведены на 105 белых крысах-самцах. ГГ моделировали, используя в 1-й группе в качестве анестетика эфир во 2-й - анестетик севофлуран. Контролем служили 2 группы интактных животных: одна - с эфиром, другая - с севофлураном. Для оценки процессов СРО через 15 мин, 30 мин, 1 ч, 2 ч ГГ забирали фрагменты тонкой кишки. Исследование хемилюминесценции (ХЛ) гомогенатов тонкой кишки проводили по методу Р.Р. Фархутдинова, используя хемилюминомер “Флюорат АБЛФ-2Т”. Регистрировались показатели СРО: спонтанная светимость (СС), вспышка (В), светосумма (С∑). Результаты. Через 15 мин ГГ (2-я группа,. севофлуран) обнаружено повышение показателя СС в тощей кишке на 33%; снижение показателя В в 12-пк в 2 раза, в тощей и подвздошной кишке - на 24 и 36% соответственно. Показатель С∑ снижался в 12-пк на 36%, в тощей и подвздошной кишке - на 45% и 52% соответственно по сравнению с 1-й группой (эфир). На 30-й мин показатель СС в тощей кишке повышался на 80%. На фоне ГГ при применении севофлурана отмечено снижение показателя В в 12-пк на 38%, в тощей кишке на 22%, а в подвздошной в 3 раза. Через 1 ч ГГ при использовании севофлурана наблюдалось повышение СС в в тощей кишке в 2 раза, в 12-пк и подвздошной - на на 38% и 15% соответственно. Показатель В снижался в 12-пк на 67, в тощей - на 43%; Показатель С∑ в 12-пк и тощей кишке снижался в 2,6 и 2,5 раза, в подвздошной - на 70% по сравнению с группой «эфир». Через 2 ч ГГ в группе «севофлуран» обнаружено увеличение СС в тощей и подвздошной кишках на 80% и в 3 раза, соответственно, по сравнению с эфирным наркозом. При этом наблюдалось уменьшение С∑ в 12-п и тощей кишке - на на 24% и 15% соответственно. Заключение. На фоне ГГ наблюдается активация процессов СРО в тонкой кишке при использовании эфира; прекондиционирование анестетиком севофлураном способствовало значительному ограничению окислительного стресса в тонкой кишке крыс возможно за счет активации антиоксидантной системы. Introduction. The major pathogenetic factor of massive blood loss is hypoxia, which triggers activation of free-radical oxidation (FRO) processes in organs and tissues and the systemic inflammatory response. A universal factor of multiple organ dysfunction in blood loss is altered intestinal wall permeability with translocation of microflora and toxins into the systemic circulation during reperfusion. Recently, much of the attention has been focused on effects of anesthetic preconditioning, including during operations associated with hemorrhagic hypotension (HH). The aim of this study was to evaluate in experiment the dynamics of small intestinal FRO in HH during the use of the anesthetic sevoflurane, which has an effect of anesthetic preconditioning. Methods. Experiments were performed on 105 white male rats divided into two groups; groups 1 and 2 were exposed to HH with ether or sevoflurane as the anesthetic, respectively. Two groups of intact animals treated with ether or sevoflurane were used as the controls. Five animals died during the experiment. To evaluate FRO processes, samples of the duodenum, jejunum, and ileum were taken at 15 min, 30 min, 1 h, and 2 h of HH. The chemiluminescence (CL) study of small intestine homogenates was performed according to the Farukhutdinov method on a Fluorate ABLF-2T chemiluninometer. The following FRO indexes were recorded: spontaneous luminosity (SL), flash (F), and light sum (L∑). Significance of differences was determined with the Mann-Whitney test. Results. In the sevoflurane group 2 compared to the ether group after 15 min of HH, SL was increased in the jejunum by 33%; F was decreased in the duodenum by 50%, in the jejunum by 24%, and in the ileum by 36%; L∑ was decreased in the duodenum by 36%, in the jejunum by 45%, and in the ileum by 52%. At 30 min, SL in the jejunum was increased by 80%. In the HH+sevoflurane group, F was decreased in the duodenum by 38%, in the jejunum by 22%, and in the ileum by 27%; L∑ in the duodenum was decreased by 44%, in the jejunum by 45%, and in the ileum by 67%. After 1 h of HH+sevofluran, SL was increased in the jejunum twofold, in the duodenum by 38% and in the ileum by 15%; F was decreased in the duodenum by 67% and in the jejunum by 43%; L∑ in the duodenum was decreased by 62%, in the jejunum by 60%, and in the ileum by 70% compared to the ether group. After 2 h of HH+sevofluran, SL was increased in the jejunum and ileum by 80% and 67%, respectively, compared to the ether group. In this process, L∑ in the duodenum was decreased by 24% and in the jejunum by 15%. Conclusion. The HH+diethyl ether exposure was associated with activation of FRO processes in the small intestine. The sevoflurane preconditioning provided a significant restriction of oxidative stress in the rat small intestine due to activation of the antioxidant system in the duodenum, jejunum, and ileum at 1 h, 15 min, and 30 min of HH, respectively.

Sevoflurane induces lung cancer cell apoptosis via inhibition of the expression of miRNA155 gene

Purpose: To determine the apoptotic effect of sevoflurane on lung cancer cells, and the underlying mechanism of action.Methods: Lung adenocarcinoma A549 cells were cultured for 24 h and divided into control group, 1% sevoflurane group and 3% sevoflurane group. The two levels of sevoflurane were provided through a gas monitor connected to each of the sevoflurane groups. The control group was not treated. Flow cytometry was used to analyze A549 cell apoptosis, while qRT-PCR was used for assay of the levels of miRNA155 in A549 cells. The protein expression of Bcl-2 was determined with immunoblotting. The percentage of apoptosis and levels of miRNA155 and Bcl-2 in the two cell lines were compared.Results: Significant differences in miRNA146a level were seen between the 3 % sevoflurane and control groups at 3 h. There was higher apoptosis in the 3 % sevoflurane group, relative to control, but miRNA155 levels in the 3 % sevoflurane group were generally less than that of the control (p < 0.05). There was lower Bcl-2 content in the 3 % sevoflurane group than in control group (p < 0.05).Conclusion: Sevoflurane exerts strong apoptotic and anti-proliferative effects on lung adenocarcinoma A549 cells via a mechanism which may be related to the downregulation of miRNA155, thereby inhibiting the expression of anti-apoptotic protein Bcl-2. This provides a new direction for research on anti-lung adenocarcinoma drugs. Keywords: Sevoflurane, Lung cancer cells, Apoptosis, Inhibition, miRNA155, Expression, Induction

Intravenous versus Volatile Anesthetic Effects on Postoperative Cognition in Elderly Patients Undergoing Laparoscopic Abdominal Surgery

Background Delayed neurocognitive recovery after surgery is associated with poor outcome. Most surgeries require general anesthesia, of which sevoflurane and propofol are the most commonly used inhalational and intravenous anesthetics. The authors tested the primary hypothesis that patients with laparoscopic abdominal surgery under propofol-based anesthesia have a lower incidence of delayed neurocognitive recovery than patients under sevoflurane-based anesthesia. A second hypothesis is that there were blood biomarkers for predicting delayed neurocognitive recovery to occur. Methods A randomized, double-blind, parallel, controlled study was performed at four hospitals in China. Elderly patients (60 yr and older) undergoing laparoscopic abdominal surgery that was likely longer than 2 h were randomized to a propofol- or sevoflurane-based regimen to maintain general anesthesia. A minimum of 221 patients was planned for each group to detect a one-third decrease in delayed neurocognitive recovery incidence in propofol group compared with sevoflurane group. The primary outcome was delayed neurocognitive recovery incidence 5 to 7 days after surgery. Results A total of 544 patients were enrolled, with 272 patients in each group. Of these patients, 226 in the propofol group and 221 in the sevoflurane group completed the needed neuropsychological tests for diagnosing delayed neurocognitive recovery, and 46 (20.8%) in the sevoflurane group and 38 (16.8%) in the propofol group met the criteria for delayed neurocognitive recovery (odds ratio, 0.77; 95% CI, 0.48 to 1.24; P = 0.279). A high blood interleukin-6 concentration at 1 h after skin incision was associated with an increased likelihood of delayed neurocognitive recovery (odds ratio, 1.04; 95% CI, 1.01 to 1.07; P = 0.007). Adverse event incidences were similar in both groups. Conclusions Anesthetic choice between propofol and sevoflurane did not appear to affect the incidence of delayed neurocognitive recovery 5 to 7 days after laparoscopic abdominal surgery. A high blood interleukin-6 concentration after surgical incision may be an independent risk factor for delayed neurocognitive recovery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

A Crossover Comparison of the Sensitivity and the Specificity between BIS and AEP in Predicting Unconsciousness in General Anesthesia

Background. There is an increasing concern of awareness and recall during general anesthesia for both the patient and the anesthetist. The bispectral index (BIS) is used to assess the level of sedation and depth of anesthesia and detect consciousness in different anesthetic drugs. Middle-latency auditory evoked potentials (AEPs) also quantify action of anesthetic drugs and detect the transition from consciousness to unconsciousness. We aim to compare the sensitivity and specificity between BIS and AEP in predicting unconsciousness in inhalational sevoflurane anesthesia and intravenous propofol anesthesia. Methods. Totally, 40 patients were randomly allocated into two groups: propofol or sevoflurane group. In the propofol group, anesthesia was induced with target-controlled infusion propofol. In the sevoflurane group, anesthesia was induced by increasing concentrations of sevoflurane. There were 3 end points during induction: sedation, unconsciousness, and anesthesia. Target and effect-site concentrations of propofol, end-tidal concentration of sevoflurane, and BIS and AEP were recorded at each stage. Results. We obtained good EC50 with both monitors, at which there is a 50% chance that the patient has reached the end point, but the index variation was affected by the anesthetic technique. Propofol had higher correlations with stage of anesthesia, BIS, and AEP than sevoflurane. BIS had higher correlations with depth of anesthesia than AEP, but we did not find an anesthetic depth monitor that had high sensitivity and specificity and is not affected by the anesthetic technique. Conclusions. The prediction powers of BIS and AEP do not seem as good as some papers mentioned.

Comparison of Use of Isoflurane or Sevoflurane for Anaesthesia Induced by Mask in Calves

Background: Inhalation anaesthesia is an effective and reliable general anaesthesia method for inactivity, analgesia, and unconsciousness in extensive surgical procedures. Although widely used, especially in small animals, there are very few studies investigated the reliability and superiority of inhalation anaesthesia in surgical procedures for ruminants. This study intended to evaluate the anaesthetic effects of isoflurane and sevoflurane in different surgical cases with endotracheal intubation following the induction of anaesthesia using a calve-specific facemask, which is not yet a routine option in cattle.Materials, Methods & Results: The study was conducted on 14 calves, from new-born up to 3 months-old, that undergoing various surgical operations. The animals were divided into isoflurane and sevoflurane groups, and each group contained 7 animals. In all cases, atropine (0.04 mg/kg was administered intramusculer as premedication before 15 min from anaesthesia induction. For induction, the anaesthetic agent was given at an inspiratory concentration of 3-5% in the isoflurane group and at an inspiratory concentration of 5 - 7% in the sevoflurane group during 5 min via mask at 15min after atropine administration. In both groups, endotracheal intubation was performed (about 1-3 min) after of general anaesthesia symptoms starting. At 5min after induction, anaesthesia was continued at 1.5 - 3% in the isoflurane group and at 2.5 - 4% in the sevoflurane group during operation. The animals were monitored during anaesthesia and, anaesthetic effect, reaction of the calve, pronounced side effects, Heart Rate (HR), Systolic Arterial Blood Pressure (SABP), Diastolic Arterial Blood Pressure (DABP), Mean Arterial Blood Pressure (MABP), Respiration Rate (RR), Pulse Rate (PR), Arterial Oxygen Saturation (SpO2) were recorded at before anaesthesia, the premedication period, 5, 15, 30, 45, 60, 75 and 90min of anaesthesia. During anaesthesia, from the clinical parameters, mucosal capillary refilling time was evaluated by applying finger pressure to the oral mucosa. Mucous membrane color was determined by observing the oral mucosa. The time for palpebral reflex and swallowing reflex disappearance was measured and processed into individual forms. Anaesthesia induction and reanimation times were determined and recorded in the forms. After the operation, the return of the swallowing reflex and the time to stand up were recorded. During the operation, urination, defecation, salivation, vomiting, animal reactions, the shape and duration of the reamination period were recorded. In the isoflurane group anaesthesia induction was 3.71 ± 0.28 min, head movements started and came to the sterno- abdominal position at 4.57 ± 0.36 min, got up at 8.71 ± 0.42 min without assistance, meanwhile. In sevoflurane group, anaesthesia induction was 2.57 ± 0.20 min, head movements started and came to the sterno- abdominal position at 3.86 ± 0.40 min, the time to stand up was determined as 6.43 ± 0.29 min. During anaesthesia, HR, SABP, DABP, MABP, RR, PR, SpO2 findings were within physiological acceptable limits in 2 groups. In terms of indicators, there were no obvious differences in either group. The results revealed no significant difference between groups during anaesthesia.Discussion: The isoflurane and sevoflurane anaesthesia used in this study provided an adequate anaesthetic effect in calves characterized by adequate analgesia and muscle relaxation without any complications. The results of our study revealed that there was no significant difference between isoflurane and sevoflurane in calves. Both anaesthetic agents can be used safely for general anaesthesia in calves.

A Co-Induction Technique Utilizing 4% Sevoflurane Followed by 0.75 mg/kg Propofol in Elderly Patients Undergoing Minimally Invasive Procedures: A Prospective Randomized Control Study

Background and Objectives: Elderly patients constitute a large segment of healthcare receivers. Considering the functional deterioration of multiple organ systems with aging, achieving a safe perioperative approach is challenging. Our aim is to study the safety and effectiveness of a genuinely regimented co-induction technique in order to minimize anesthesia-related complications. Materials and Methods: One hundred and five patients were assigned to three groups according to the induction technique: propofol, sevoflurane and co-induction group. Inclusion criteria: patients with age ≥65 and American Society of Anesthesiologists physical status classification (ASA) II-III who underwent endoscopic urological procedures. The propofol group received a dose of 1.5 mg kg−1 of propofol over two minutes for induction. The sevoflurane group received 8% of sevoflurane and 100% oxygen through a plastic facemask with the fresh gas flow set at 8 L min−1. The co-induction group received 4% sevoflurane through plastic facemask for two minutes, followed by a 0.75 mg kg−1 dose of propofol. After ensuring full range jaw relaxation, the laryngeal mask airway (LMA) was inserted. Results: Overall, the co-induction technique had a favorable profile in terms of respiratory adverse events, while the sevoflurane group had a favorable profile in terms of hemodynamic stability. Furthermore, 24 (68.6%) patients receiving inhalational sevoflurane had episodes of transient apnea, which constitutes 77.4% of the 31 episodes of transient apnea in the studied sample (p < 0.001). Moreover, six (17.1%) patients in the sevoflurane group had an episode of partial laryngospasm (p = 0.034). Compared with the co-induction group, we found that the propofol group had significantly less systolic and diastolic blood pressures in the second minute, with p values of (0.018) and (0.015), respectively. Conclusions: The co-induction technique utilizing 4% sevoflurane at 8 L min−1 flow of oxygen inhaled over two minutes followed by 0.75 mg kg−1 of propofol achieved less respiratory adverse events compared with the sevoflurane group, and less hemodynamic instability compared with the propofol group.