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Cells Oct 2023Cerebral injury is a leading cause of long-term disability and mortality. Common causes include major cardiovascular events, such as cardiac arrest, ischemic stroke, and... (Review)
Review
Cerebral injury is a leading cause of long-term disability and mortality. Common causes include major cardiovascular events, such as cardiac arrest, ischemic stroke, and subarachnoid hemorrhage, traumatic brain injury, and neurodegenerative as well as neuroinflammatory disorders. Despite improvements in pharmacological and interventional treatment options, due to the brain's limited regeneration potential, survival is often associated with the impairment of crucial functions that lead to occupational inability and enormous economic burden. For decades, researchers have therefore been investigating adjuvant therapeutic options to alleviate neuronal cell death. Although promising in preclinical studies, a huge variety of drugs thought to provide neuroprotective effects failed in clinical trials. However, utilizing medical gases, noble gases, and gaseous molecules as supportive treatment options may offer new perspectives for patients suffering neuronal damage. This review provides an overview of current research, potentials and mechanisms of these substances as a promising therapeutic alternative for the treatment of cerebral injury.
Topics: Humans; Neuroprotection; Noble Gases; Gases; Neuroprotective Agents; Brain Injuries; Neurons
PubMed: 37887324
DOI: 10.3390/cells12202480 -
Anesthesiology Dec 2023Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence...
BACKGROUND
Processed electroencephalography (EEG) is used to monitor the level of anesthesia, and it has shown the potential to predict the occurrence of delirium. While emergence trajectories of relative EEG band power identified post hoc show promising results in predicting a risk for a delirium, they are not easily transferable into an online predictive application. This article describes a low-resource and easily applicable method to differentiate between patients at high risk and low risk for delirium, with patients at low risk expected to show decreasing EEG power during emergence.
METHODS
This study includes data from 169 patients (median age, 61 yr [49, 73]) who underwent surgery with general anesthesia maintained with propofol, sevoflurane, or desflurane. The data were derived from a previously published study. The investigators chose a single frontal channel, calculated the total and spectral band power from the EEG and calculated a linear regression model to observe the parameters' change during anesthesia emergence, described as slope. The slope of total power and single band power was correlated with the occurrence of delirium.
RESULTS
Of 169 patients, 32 (19%) showed delirium. Patients whose total EEG power diminished the most during emergence were less likely to screen positive for delirium in the postanesthesia care unit. A positive slope in total power and band power evaluated by using a regression model was associated with a higher risk ratio (total, 2.83 [95% CI, 1.46 to 5.51]; alpha/beta band, 7.79 [95% CI, 2.24 to 27.09]) for delirium. Furthermore, a negative slope in multiple bands during emergence was specific for patients without delirium and allowed definition of a test for patients at low risk.
CONCLUSIONS
This study developed an easily applicable exploratory method to analyze a single frontal EEG channel and to identify patterns specific for patients at low risk for delirium.
Topics: Humans; Middle Aged; Anesthesia Recovery Period; Anesthesia, General; Delirium; Propofol; Sevoflurane; Electroencephalography
PubMed: 37616326
DOI: 10.1097/ALN.0000000000004754 -
The Lancet. Planetary Health Jul 2023There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce... (Review)
Review
There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce pollution from clinical practice. Inhaled anaesthetics is a particular research area of interest for two reasons. First, several gases are potent greenhouse gases, and waste gas is mostly emitted directly to the environment. Second, there are options to reduce gas waste and substitute medications and procedures with fewer embodied emissions while delivering high-quality care. Performance improvements are contingent on a proper understanding of the emission estimates and climate metrics used to ensure consistent application in guiding mitigation strategies and accounting at various scales. We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs: desflurane, sevoflurane, isoflurane, methoxyflurane, and nitrous oxide.
Topics: Anesthetics, Inhalation; Climate; Methoxyflurane; Isoflurane; Sevoflurane; Gases
PubMed: 37438003
DOI: 10.1016/S2542-5196(23)00084-0 -
Asian Journal of Neurosurgery Dec 2023The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in...
The choice of inhalational or intravenous anesthetic agents is debatable in neurosurgical patients. Desflurane, a cerebral vasodilator, may be advantageous in ischemic cerebral pathologies. Hence, we planned to compare desflurane and propofol in patients with moyamoya disease (MMD) with the objective of comparing neurological outcomes. This prospective pilot trial was initiated after institutional ethics committee approval. Patients with MMD undergoing revascularization surgery were randomized into two groups receiving either desflurane or propofol intraoperatively. Neurological outcomes were assessed using a modified Rankin score (mRS) at discharge and an extended Glasgow outcome score (GOS-E) at 1 month. Intraoperative parameters, including hemodynamic parameters, end-tidal carbon dioxide, entropy, intraoperative brain relaxation scores (BRS), and rescue measures for brain relaxation, were compared. The normality of quantitative data was checked using Kolmogorov-Smirnov tests of normality. Normally distributed data were compared using unpaired -tests, skewed data using Mann-Whitney U tests, and categorical variables using chi-squared tests. A total of 17 patients were randomized, 10 in the desflurane and 7 in the propofol group. mRS (1.3 ± 0.6 and 1.14 ± 0.4, = 0.450) and GOS-E (6.7 ± 0.6 and 6.85 ± 0.5, = 0.45) were comparable between desflurane and propofol groups, respectively. BRS was significantly higher in the desflurane group (3.6 ± 0.5) compared to the propofol group (2.1 ± 0.3, = 0.001), with a significant number of patients requiring rescue measures in the desflurane group (70%, < 0.001). Other outcome parameters were comparable ( > 0.05). We conclude that postoperative neurological outcomes were comparable with using either an anesthetic agent, desflurane, or propofol in MMD patients undergoing revascularization surgery. Maintenance of anesthesia with propofol had significantly superior surgical field conditions.
PubMed: 38161613
DOI: 10.1055/s-0043-1775588 -
Frontiers in Pharmacology 2024Many respiratory but few arterial blood pharmacokinetics of desflurane uptake and disposition have been investigated. We explored the pharmacokinetic parameters in...
INTRODUCTION
Many respiratory but few arterial blood pharmacokinetics of desflurane uptake and disposition have been investigated. We explored the pharmacokinetic parameters in piglets by comparing inspiratory, end-tidal, arterial blood, and mixed venous blood concentrations of desflurane.
METHODS
Seven piglets were administered inspiratory 6% desflurane by inhalation over 2 h, followed by a 2-h disposition phase. Inspiratory and end-tidal concentrations were detected using an infrared analyzer. Femoral arterial blood and pulmonary artery mixed venous blood were sampled to determine desflurane concentrations by gas chromatography at 1, 3, 5, 10, 20, 30, 40, 50, 60, 80, 100, and 120 min during each uptake and disposition phase. Respiratory and hemodynamic parameters were measured simultaneously. Body uptake and disposition rates were calculated by multiplying the difference between the arterial and pulmonary artery blood concentrations by the cardiac output.
RESULTS
The rates of desflurane body uptake increased considerably in the initial 5 min (79.8 ml.min) and then declined slowly until 120 min (27.0 ml.min). Similar characteristics of washout were noted during the subsequent disposition phase. Concentration-time curves of end-tidal, arterial, and pulmonary artery blood concentrations fitted well to zero-order input and first-order disposition kinetics. Arterial and pulmonary artery blood concentrations were best fitted using a two-compartment model. After 2 h, only 21.9% of the desflurane administered had been eliminated from the body.
CONCLUSION
Under a fixed inspiratory concentration, desflurane body uptake in piglets corresponded to constant zero-order infusion, and the 2-h disposition pattern followed first-order kinetics and best fitted to a two-compartment model.
PubMed: 38628643
DOI: 10.3389/fphar.2024.1339690