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Xu Y, Xie CB, Yang J, Xing YJ, Xia WP, Liu Y, Xi WB, Li ZJ, Tu WF, Zhang JL. Association between telomere length in the DNA of peripheral blood leukocytes and the propofol dose in anesthesia induction: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:764-768. [PMID: 34119568 PMCID: PMC10625149 DOI: 10.1016/j.bjane.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 05/03/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. Telomerase RNA component (TERC) plays an important role in maintaining TL. We proposed a hypothesis that propofol dose in general anesthesia can be predicted by measuring TL before operation, which greatly reduced the risk of anesthesia, especially the elderly. METHODS The association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight; sex; difference of the Bispectral Index (BIS) before and after anesthesia induction in patients was evaluated by multivariable linear regression analyses. The mutation at the 5'end or 3'end of TERC was detected. We recruited 100 patients of elective surgery. RESULTS We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p < 0.001), body weight (r = 0.84, p = 0.004), sex (r = 0.83, p= 0.84, p = 0.004), sex (r = 0.83, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.21, 0.19, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, the mutation at the 5' end or 3' end of TERC was not found. CONCLUSIONS These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.
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Affiliation(s)
- Yan Xu
- The 74th Group Army Hospital of P.L.A, Guangzhou, China
| | - Chuang Bo Xie
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Department of Anesthesiology, Guangzhou, China; General Hospital of Southern Theatre Command, Department of Anesthesiology, Guangzhou, China
| | - Jing Yang
- Third Affiliated Hospital, Sun Yat-sen University, Department of Anesthesiology, Guangzhou, China
| | - Yong Ji Xing
- The 74th Group Army Hospital of P.L.A, Guangzhou, China
| | - Wei Ping Xia
- The 74th Group Army Hospital of P.L.A, Guangzhou, China
| | - Yang Liu
- 32295 troops of P.L.A, Liaoyang, China
| | - Wen Bin Xi
- General Hospital of Southern Theatre Command, Department of Anesthesiology, Guangzhou, China
| | - Zhao Ju Li
- General Hospital of Southern Theatre Command, Department of Anesthesiology, Guangzhou, China
| | - Wei Feng Tu
- General Hospital of Southern Theatre Command, Department of Anesthesiology, Guangzhou, China
| | - Jun Long Zhang
- The Affiliated Lianyungang No. 2 People...s Hospital of Jiangsu University, Department of Anesthesiology, Lianyungang, China.
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Huang C, Li Z, Long Y, Li D, Huang M, Ding B, Zhu W. A comprehensive evaluation between dexmedetomidine and midazolam for intraoperative sedation in the elderly: protocol for a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022; 11:278. [PMID: 36564829 PMCID: PMC9784254 DOI: 10.1186/s13643-022-02144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The sedative effect of intraoperative sedation in elderly surgery exerts critical influence on the prognosis. Comparison on the safety and efficacy between dexmedetomidine and midazolam in many clinical randomized controlled trials (RCTs) was inconsistent and suspicious. We aim to comprehensively evaluate the safety and efficacy between dexmedetomidine and midazolam for intraoperative sedation in the elderly via meta-analysis and systematic reviews. METHODS RCTs regarding to the comparison of sedative effects and safety between dexmedetomidine and midazolam in elderly patients (aged ≥ 60 years) will be comprehensively searched from 2000 October to 2022 May through 4 English databases and 4 Chinese databases. After extraction in duplicate, the systematic review and meta-analysis will be performed on the primary outcomes (hemodynamic changes, sedative effect, cognitive function) and secondary outcomes (analgesic effect, surgical characteristics, complications, or adverse reactions) for assessing the two therapy methods using Review Manager software (Version 5.3). Sensitivity analysis will be conducted to evaluate the heterogeneity of the results; funnel plot and Egger's trial will be performed to analyze publication bias of the included studies, and trial sequential analysis will be applied to assess the robustness and reliability of preliminary meta-analysis results. Finally, rating quality of evidence and strength of recommendations on the meta results will be summarized by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. DISCUSSION This systematic review and meta-analysis will evaluate the safety and efficacy between dexmedetomidine and midazolam for intraoperative sedation in the elderly; it will give an insight on the application of dexmedetomidine and midazolam and will provide evidence-based reference for clinical decision-making. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021221897.
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Affiliation(s)
- Chunxia Huang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zunjiang Li
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yingxin Long
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dongli Li
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Manhua Huang
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Banghan Ding
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. .,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
| | - Wei Zhu
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China. .,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
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Sotoudeh N, Namavar MR. Optimisation of ketamine‐xylazine anaesthetic dose and its association with changes in the dendritic spine of CA1 hippocampus in the young and old male and female Wistar rats. Vet Med Sci 2022; 8:2545-2552. [DOI: 10.1002/vms3.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Narges Sotoudeh
- Department of Anatomical Sciences School of Medicine, Shiraz University of Medical Sciences Shiraz Iran
- Histomorphometry and Stereology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Mohammad Reza Namavar
- Department of Anatomical Sciences School of Medicine, Shiraz University of Medical Sciences Shiraz Iran
- Clinical Neurology Research Center Shiraz University of Medical Sciences Shiraz Iran
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Zhang Y, Lv YL, Si YN, Zhou J, Qian Y, Bao HG. α-lipoic acid attenuates spatial learning and memory impairment induced by hepatectomy. Exp Ther Med 2019; 17:2329-2333. [PMID: 30867718 DOI: 10.3892/etm.2019.7202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 11/19/2018] [Indexed: 01/07/2023] Open
Abstract
The aim of the present study was to compare the effects of α-lipoic acid (ALA) on postoperative cognitive dysfunction (POCD) between wild type (WT) and leptin receptor-deficient (db/db) mice and to elucidate the underlying mechanism of treatment with ALA. The present study compared the effects of ALA on spatial learning and memory of WT and db/db mice using a Morris water maze following hepatectomy. The expression levels of proteins, including cyclin-dependent kinase 5 (Cdk5), tau, phosphorylated tau and amyloid β (Aβ) were measured in the hippocampus. Surgery impaired postoperative cognitive function in both WT and db/db mice. Furthermore, the expression levels of Cdk5 and Aβ, and the phosphorylation of tau in the hippocampus increased after the surgery in both WT and db/db mice. The ultrastructure of hippocampal neurons and synapses was analyzed by transmission electron microscopy and the results revealed that surgery damaged the structure of neurons and synapses in both WT and db/db mice. Treatment with ALA protected the postoperative cognitive function and the structure of hippocampal neurons and synapses, and prevented the increase in protein expression levels of Cdk5 and Aβ, and the phosphorylation of tau in the hippocampus of WT but not db/db mice. The results of the present study suggest that ALA may be used for the treatment of POCD. The molecular mechanisms underlying the activity of ALA require further investigation.
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Affiliation(s)
- Yuan Zhang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Yun-Luo Lv
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Yan-Na Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Jianwei Zhou
- Deparment of Molecular Cell Biology and Toxicology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu 211166, P.R. China
| | - Yanning Qian
- Department of Anesthesiology, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Hong-Guang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
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Giroux MC, Santamaria R, Hélie P, Burns P, Beaudry F, Vachon P. Physiological, pharmacokinetic and liver metabolism comparisons between 3-, 6-, 12- and 18-month-old male Sprague Dawley rats under ketamine-xylazine anesthesia. Exp Anim 2015; 65:63-75. [PMID: 26489361 PMCID: PMC4783652 DOI: 10.1538/expanim.15-0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The main objective of this study was to compare the physiological changes (withdrawal and
corneal reflexes, respiratory and cardiac frequency, blood oxygen saturation, and rectal
temperature) following intraperitoneal administration of ketamine (80 mg/kg) and xylazine
(10 mg/kg) to 3-, 6-, 12- and 18-month-old male Sprague Dawley rats (n=6/age group).
Plasma pharmacokinetics, liver metabolism, and blood biochemistry were examined for a
limited number of animals to better explain anesthetic drug effects. Selected organs were
collected for histopathology. The results for the withdrawal and corneal reflexes suggest
a shorter duration and decreased depth of anesthesia with aging. Significant cardiac and
respiratory depression, as well as decreased blood oxygen saturation, occurred in all age
groups however, cardiac frequency was the most affected parameter with aging, since the
6-, 12-, and 18-month-old animals did not recuperate to normal values during recovery from
anesthesia. Pharmacokinetic parameters (T1/2 and AUC) increased and drug
clearance decreased with aging, which strongly suggests that drug exposure is associated
with the physiological results. The findings for liver S9 fractions of 18-month-old rats
compared with the other age groups suggest that following a normal ketamine anesthetic
dose (80 mg/kg), drug metabolism is impaired, leading to a significant increase of drug
exposure. In conclusion, age and related factors have a substantial effect on ketamine and
xylazine availability, which is reflected by significant changes in pharmacokinetics and
liver metabolism of these drugs, and this translates into shorter and less effective
anesthesia with increasing age.
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Affiliation(s)
- Marie-Chantal Giroux
- Department of Veterinary Biomedicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
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Giroux MC, Hélie P, Burns P, Vachon P. Anesthetic and pathological changes following high doses of ketamine and xylazine in Sprague Dawley rats. Exp Anim 2015; 64:253-60. [PMID: 25818316 PMCID: PMC4547998 DOI: 10.1538/expanim.14-0088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The main objective of this study was to compare the effects of ketamine and xylazine in aging rats when coadministered intraperitoneally at high anesthetic doses. Three groups (n=6 rats/group) consisting of rats at 3, 6 and 12 months of age were used. During anesthesia, animals were monitored for heart rate, respiratory frequency, blood oxygen saturation, and rectal temperature. The corneal and paw withdrawal reflex were also examined during anesthesia. During anesthesia, withdrawal and corneal reflexes were absent for progressively longer durations with increasing age. Significant decreases in cardiac and respiratory frequency and, blood oxygen saturation occurred for the 6- and 12-month-old animals. Respiratory frequency and blood oxygen saturation returned to normal at the end of the anesthesia; however, the significant decrease in cardiac frequency persisted in the 6- and 12-month-old animals. Rectal temperature was decreased significantly only in the 3-month-old animals. Pulmonary edema and effusion occurred in 50% of the 12-month-old animals. In conclusion, if ketamine-xylazine are used for anesthesia, the doses should be optimized for the age of the subjects prior to initiation of the research project.
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Affiliation(s)
- Marie-Chantal Giroux
- Faculty of Veterinary Medicine, Departments of Veterinary Biomedicine, University of Montreal, 3200 rue Sicotte, Saint-Hyacinthe, Quebec, J2S 2M2, Canada
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Scandroglio AM, Finco G, Pieri M, Ascari R, Calabrò MG, Taddeo D, Isella F, Franco A, Musu M, Landoni G, Alfieri O, Zangrillo A. Cardiac surgery in 260 octogenarians: a case series. BMC Anesthesiol 2015; 15:15. [PMID: 25685057 PMCID: PMC4328195 DOI: 10.1186/1471-2253-15-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 01/15/2015] [Indexed: 11/21/2022] Open
Abstract
Background The elderly undergo cardiac surgery more and more frequently, often present multiple comorbidities, assume chronic therapies, and present a unique physiology. Aim of our study was to analyze the experience of a referral cardiac surgery center with all types of cardiac surgery interventions performed in patients ≥80 years old over a six years’ period. Methods A retrospective observational study performed in a university hospital. 260 patients were included in the study (3.5% of the patients undergoing cardiac surgery in the study period). Results Mean age was 82 ± 1.8 years. Eighty-five percent of patients underwent elective surgery, 15% unplanned surgery and 4.2% redo surgery. Intervention for aortic valve pathology and coronary artery bypass grafting were performed in 51% and 46% of the patients, respectively. Interventions involving the mitral valve were the 26% of the total, those on the tricuspid valve were 13% and those on the ascending aortic arch the 9.6%. Postoperative low output syndrome was identified in 44 patients (17%). Mortality was 3.9% and most of the patients (91%) were discharged from hospital in good clinical conditions. Hospital mortality was lower in planned vs unplanned surgery: 3.8% vs 14% respectively. Chronic obstructive pulmonary disease (OR 9.106, CI 2.275 – 36.450) was the unique independent predictor of mortality. Conclusions Clinicians should be aware that cardiac surgery can be safely performed at all ages, that risk stratification is mandatory and that hemodynamic treatment to avoid complications is expected. Electronic supplementary material The online version of this article (doi:10.1186/1471-2253-15-15) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Gabriele Finco
- Department of Medical Sciences "M. Aresu", Cagliari University, Cagliari, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Roberto Ascari
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Daiana Taddeo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesca Isella
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Annalisa Franco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Mario Musu
- Department of Medical Sciences "M. Aresu", Cagliari University, Cagliari, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
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Prescription des médicaments chez les personnes âgées : des améliorations sont nécessaires. Presse Med 2013; 42:168-70. [DOI: 10.1016/j.lpm.2012.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 11/15/2022] Open
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