Propofol Alleviates Neuropathic Pain Induced by Chronic Contractile Injury by Regulating the Spinal glun2b-p38mapkepac1 Pathway

Background. Propofol acts as an intravenous anesthetic cure which is widely used as a therapy for the craniocerebral injury that comprised surgical anesthesia as well as the sedation done in the intensive care units. Propofol is one of the most commonly used and efficient anesthetics where the painful effects are followed by an injection of propofol. In many cases, patients experience pain followed by anxiety, boredom, fear, and even myocardial ischemia. Objective. This study was performed to investigate the underlying mechanism of propofol and its effect on regulating spinal glun2b-p38mapkepac1 pathways in chronic contractile injury. Material and Methods. Contractile injury was performed by ligation around the nerve of the thigh region postanesthesia. Rats were divided into three groups to analyze the changes like mechanical allodynia by the paw withdrawal threshold and histopathological analysis for assessing cellular degradation. L4-L6 from the spinal dorsal horns were isolated and harvested for studying protein expression, by the method of western blotting and immunofluorescence analysis. Results. The pain caused due to mechanical allodynia in the paw region was highest at 1 hour postinduction and lasted for three days postinjury. Pain was significantly less in the group receiving propofol when compared with the isoflurane group for the first two hours of injury. In the propofol group, EPAC1, GluN2B, and p38 MAP K were significantly lower. Conclusion. In the rat model of induced chronic contractile injury, postsurgery there was a suppression of the GluN2B-p38MAPK/EPAC1 signaling pathway in the propofol group. As the p38MAPK/EPAC pathway has a significant role in the postoperative hyperalgesia, thus our experiment suggests that propofol has analgesic effects.

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.

Dexmedetomidine reduces isoflurane-induced neuroapoptosis through regulating BDNF and proBDNF

Background: It is well-acknowledged that Isoflurane induces neuroapoptosis in neonatal rats. Dexmedetomidine, as an α2-adrenergic agonist, was previously demonstrated to provide neuroprotection when administered during isoflurane anesthesia. Our study aims to investigate the mechanisms concerning the neuroprotective effect of dexmedetomidine from the alterations of BDNF,ERK, and JNK signals in the hippocampal region. Methods: Neonatal Sprague-Dawley rats at postnatal day 7 were assigned into Control group, Isoflurane group, Dexmedetomidine group and Inhibitor group. After exposed to 2% isoflurane in 40% of oxygen mixed with nitrogen for 4h, the hippocampus tissues were separated and critical signal pathway proteins of BDNF, proBDNF, JNK, ERK, and caspase 3 were detected. Results: Neuroapoptosis was triggered by Isoflurane with the increased expression of caspase 3 and TUNEL-positive cells. This effect was reversed by dexmedetomidine accompanying with up-regulation of BDNF and phospho-ERK and down-regulation of proBDNF and phospho-JNK. Conclusions: This study revealed that dexmedetomidine pretreatment can attenuate neurotoxicity caused by isoflurane in neonatal rats by regulating BDNF, proBDcNF, ERK, and JNK, which would provide a new target for neuroprotection.

Effects on the Lipid Peroxidation and the Antioxidant Defense Systems of the Use of Isoflurane or Sevoflurane in Calves Undergoing Surgery

Background: Incoming anaesthesia created by the use of many drugs with different physicochemical properties is a source of stress and trauma for the body. This event increases the oxidative response and changes the balance between oxidant/antioxidant capacity in the organism in favor of oxidant capacity. This situation is defined as oxidative stress. For these reasons, studies are conducted to determine the effects of general anaesthetic agents on oxidant and antioxidant systems in the organism. In this study, it was aimed to determine the effects of isoflurane and sevoflurane used for general anaesthesia in humans and animals on lipid peroxidation and antioxidant defense system in calves.Materials, Methods & Results: The study included 14 calves of different breeds, ages, sexes, and weighing, average 2 weeks old. The cases randomly were divided into 2 groups, the isoflurane group (group I), and the sevoflurane group (group II), and each group included 7 animals. Before general anaesthesia, 0.04 mg/kg atropine was administered intramuscularly to all animals for premedication. At 15 min after atropine administration, isoflurane was administered at an inspiratory concentration of 3-5% in group I, and sevoflurane was administered at an inspiratory concentration of 5-7% in group II, via a face mask for 15 min for the induction of anaesthesia. Endotracheal intubation was performed in all cases at the 15min of the induction period following the onset of general anaesthesia symptoms. After the induction, anaesthesia was continued at an inspiratory concentration of 1.5-3% in the isoflurane group and inspiratory concentration of 2.5-4% in the sevoflurane group. Blood samples were taken just before anaesthesia, just before skin incision, at the end of anaesthesia and surgery, and at the 24h postoperatively. The malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and glutathione (GSH) levels were measured spectrophotometrically in samples. In group I, MDA and antioxidant parameters SOD, CAT, GSH-Px, GSH did not observe a significant change in their concentrations through the study (P > 0.05). In group II, MDA value decreased significantly before incision (P < 0.05), at the end of anaesthesia and surgery compared to the pre-anaesthesia level (P < 0.001), and then although increased significantly at 24th-h postoperatively, the value was still lower than the pre-anaestesia level (P < 0.05). It was determined that SOD activity increased significantly after sevoflurane compared to pre-anaesthesia (P < 0.05) however, the increases in SOD activity detected during sevoflurane were not statistically significant (P > 0.05). During the study, a statistically insignificant increase was observed in the concentrations of CAT, GSH-Px, GSH compared to pre-anaesthesia (P > 0.05). Pre-anaesthesia values of all measured biochemical parameters did not differ significantly between groups (P > 0.05). Before skin incision, at the end of anaesthesia and surgery, and at the 24h postoperatively MDA was lower (P < 0.05) and SOD activity was higher (P < 0.05) than in group I in group II. There was no statistically significant difference between the two groups in terms of CAT, GSH-Px, GSH levels between the other measurement times (P > 0.05). Discussion: An important advantage of sevoflurane compared to currently available anaesthetics is that it provides rapid induction due to its low solubility in blood and tissues, and rapid recovery due to its low solubility in fat. This feature is proof that the side effects of sevoflurane anaesthesia are minimal. The findings of this study show that sevoflurane exposure decreases lipid peroxidation and enhances antioxidant defense. The potential effect of sevoflurane on oxidative stress may lead to its preferred clinical use of sevoflurane compared to isoflurane.

Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock

Funding Acknowledgements Type of funding sources: None. Objectives (Background): The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown. Design Retrospective single-center study Patients/subjects: Cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane between November 2018 and October 2019 have been enrolled in this study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients treated between January 2013 and November 2018 from the cardiogenic shock registry of our university hospital. Measurements and Main Results: Isoflurane sedation was used in 32 patients with cardiogenic shock and VA-ECMO treatment. The mean age of conventionally sedated patients was 58.4 ± 13.8 years and 56.3 ± 11.5 years for patients with isoflurane sedation (p = 0.51). Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p = 0.01). Mean systolic arterial pressure was similar (94.3 ± 12.6 mmHg versus 92.9 ± 10.5 mmHg, p = 0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2 ± 20.5 /min vs. 74.7 ± 15.0 /min; p = 0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304 ± 143 h vs. 398 ± 272 h,p = 0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p = 0.76) and 30 day-mortality (59.2% vs. 63.4%, p = 0.80) were similar in both groups. The overall sedation costs per patient were significantly lower in the conventional group, when compared to the isoflurane group (537 ± 624 € vs. 1280 ± 837 €, p &lt; 0.001). Conclusions Volatile sedation with isoflurane is feasible – albeit at higher costs - in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation.

Effects of propofol, desflurane and isoflurane on perioperative blood glucose level in intracranial mass operation: A randomized controlled trial

The aim of this study is to compare the effects of the propofol, desflurane and isoflurane on blood glu-cose levels in cranial surgery. Ninety, ASA I-II patients aged between 18-60 years old were scheduled for study. Induction was per-formed with fentanyl, propofol and cisatracurium in all patients. Anaesthesia was maintained using propofol 4-6 mg/kg/h in propofol group (Group P), desflurane and isoflurane 0.5-1 MAC in group desflurane (Group D) and group isoflurane (Group I). Remifentanil infusion was applied 0.5 µg/kg/min in all groups. Plasma glucose (PG) levels, systolic arterial pressure (SAP), diastolic arterial pressure, mean arterial pressure and heart rate measured. In the 1st, 2nd and 5th hour, PG levels were significantly lower in group P than group D. In the 2nd and 3rd hour, PG levels were significantly lower in group P than group I (p <0.05). In addition, SAP values in group D were found to be significantly lower than group P and group I. With this study, it was concluded that total intravenous anesthesia with propofol infusion in intracranial mass surgery is more effective than inhalation anesthesia such as desflurane and isoflurane in preventing the hyperglycemic response caused by surgical stress.

Anaesthetic and electrocardiograpic profiles in prolonged inhalation anaesthesia in Nigerian indigenous dogs

Electrocardiograph during anaesthesia provides information on cardiac electrical activity which may affect cardiac function. This study was carried out to evaluate the effect of prolonged volatile anaesthesia using halothane and isoflurane on the electrographic and anaesthetic profiles in Nigerian dogs. They were prepared for anaesthesia and connected to a 5-lead patient monitor (GMI®). Venous access was secured and lactated ringer's solution administered at a maintenance flow rate of 5mlkghr-1.Tracheae were intubated following induction with thiopentone and anaesthesia maintained with 0.5% halothane (group A) and 2.0% isoflurane (group B) in 2liters/minute oxygen respectively with the animals breathing spontaneously. The readings were taken, prior to induction of anaesthesia (control) and every 30 minutes thereafter for six hours during anaesthesia. Data were presented as mean and standard deviation.Differences were considered significant at p≤0.05. The values of ST segment (sec) and P-waves (sec) were both low, 0.068 ± 0.013 and 0.064 ± 0.017 and 0.020 ± 0.001 and 0.020 ± 0.001 respectively for isoflurane and halothane. However the values of P-waves (mV) and P-R intervals (sec) were significantly higher in group A, (0.193 ±0.136 and 0.046 ±0.01) compared to group B, 0.193 ± 0.98 and 0.039 ± 0.01 respectively. Isoflurane produced prolongation of Q-T intervals (sec) and QRS complex (sec), 0.123 ± 0.018 and 0.023 ± 0.008 compared to halothane, 0.121 ± 0.023 and 0.021 ± 0.005. The ECG parameters measured revealed no adverse effect of halothane or isoflurane on the heart in Nigerian local dogs.There was prolonged QT interval in group B. In conclusion, halothane appears a better drug of choice in prolonged anaesthesia in Nigerian dogs.

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.

The differential effects of isoflurane and sevoflurane on neonatal mice

Previous research has shown that exposure to volatile anesthetics can induce acute neuroinflammation and neuroapoptopsis in neonatal rodents and that these events can lead to cognitive dysfunction at later stages. Isoflurane and sevoflurane are two of the most popular anesthetics used in the field of pediatrics. However, the relative impact of these two anesthetics on the developing brain at distinct time points after the induction of anesthesia has not been compared. In the present study, we exposed 7-day-old mice to clinically equivalent doses of isoflurane (1.5%) and sevoflurane (2.5%) for 4 h and then investigated consequential changes in the brains of these mice at six different time points. We analyzed the levels of proteins that are directly related to neuroapoptosis, neuroinflammation, synaptic function, and memory, in the brains of neonatal mice. Exposure of neonatal mice to isoflurane and sevoflurane resulted in acute neuronal apoptosis. Our analysis observed significant levels of neuroinflammation and changes in the expression levels of proteins associated with both synaptic transmission and memory in mice from the isoflurane group but not the sevoflurane group. Our results therefore indicate that isoflurane and sevoflurane induce differential effects in the brains of neonatal mice.

Isoflurane sedation in patients undergoing VA-ECMO treatment for cardiogenic shock – an observational propensity-matched study

Introduction The feasibility and hemodynamic effects of isoflurane sedation in cardiogenic shock in the presence of extracorporeal membrane oxygenation (VA-ECMO) treatment is currently unknown. Methods Thirty-two cardiogenic shock patients with VA-ECMO treatment under sedation with volatile isoflurane on a cardiac intensive care unit have been enrolled in this retrospective single-center study and were matched by propensity score in a 1:1 ratio with intravenously (IV) sedated patients. Results Administration of isoflurane was associated with lower IV sedative drug use during VA-ECMO treatment (86% vs. 32%, p=0.01). Mean systolic arterial pressure was similar (94.3±12.6 mmHg versus 92.9±10.5 mmHg, p=0.65), but mean heart rate was significantly higher in the conventional sedation group, when compared to the isoflurane group (85.2±20.5 / min vs. 74.7±15.0 /min; p=0.02). Catecholamine doses, VA-ECMO blood and gas flow, ventilation time (304±143 h vs. 398±272 h, p=0.16), bleeding complications BARC3a or higher (59.3% vs. 65.3%, p=0.76) and 30-day mortality (59.2% vs. 63.4%, p=0.80) were similar in both groups. Conclusions Volatile sedation with isoflurane is feasible in patients with cardiogenic shock and VA-ECMO treatment and was not associated with higher catecholamine dosage or ECMO flow rate compared to IV sedation. Mortality and bleeding Funding Acknowledgement Type of funding source: None