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Linassi F, De Laurenzis A, Maran E, Gadaldi A, Spano' L, Gerosa G, Pittarello D, Zanatta P, Carron M. Influence of Previous General Anesthesia on Cognitive Impairment: An Observational Study Among 151 Patients. Front Hum Neurosci 2022; 16:810046. [PMID: 35652004 PMCID: PMC9148968 DOI: 10.3389/fnhum.2022.810046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Preoperative neurocognitive disorder (preO-NCD) is a common condition affecting 14–51. 7% of the elderly population. General anesthesia has already been associated with the one-year post-operative neurocognitive disorder (PostO-NCD), specifically, a deficit in executive function, measured by the Trail Making Test B (TMT-B), but its long-term effects on cognitive function have not been investigated. We aimed to detect preO-NCD prevalence in patients scheduled for cardiac surgery and further investigate the possible role of previous general anesthesia (pGA) in general preoperative cognitive status [measured via the Montreal Cognitive Assessment (MoCA)] and/or in executive functioning (measured via TMT-B). Methods In this observational, prospective study, 151 adult patients scheduled for elective cardiac surgery underwent MoCA and TMT-B. Data on age, education, pGA, comorbidities, and laboratory results were collected. Results We discovered a general cognitive function impairment of 79.5% and an executive function impairment of 22%. Aging is associated with an increased likelihood (OR 2.99, p = 0.047) and education with a decreased likelihood (OR 0.35, p = 0.0045) of general cognitive impairment, but only education was significantly associated with a decreased likelihood (OR 0.22, p = 0.021) of executive function impairment. While pGA did not significantly affect preO-NCD, a noteworthy interaction between aging and pGA was found, resulting in a synergistic effect, increasing the likelihood of executive function impairment (OR 9.740, p = 0.0174). Conclusion We found a high prevalence of preO-NCD in patients scheduled for cardiac surgery. General cognitive function impairment is highly associated with advancing age (not pGA). However, older patients with at least one pGA appeared to be at an increased risk of preO-NCD, especially executive function impairment, suggesting that TMT-B should be associated with MoCA in the preoperative cognitive evaluation in this population.
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Affiliation(s)
- Federico Linassi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
- *Correspondence: Federico Linassi
| | - Alessandro De Laurenzis
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Eleonora Maran
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Alessandra Gadaldi
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Leonardo Spano'
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Paolo Zanatta
- Department of Anesthesia and Intensive Care, Integrated University Hospital of Verona, Verona, Italy
| | - Michele Carron
- Department of Medicine, Anaesthesiology and Intensive Care, University of Padova, Padova, Italy
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Baxter MG, Mincer JS, Brallier JW, Schwartz A, Ahn H, Nir T, McCormick PJ, Ismail M, Sewell M, Allore HG, Ramsey CM, Sano M, Deiner SG. Cognitive Recovery by Decade in Healthy 40- to 80-Year-Old Volunteers After Anesthesia Without Surgery. Anesth Analg 2022; 134:389-399. [PMID: 34889804 PMCID: PMC8760160 DOI: 10.1213/ane.0000000000005824] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Postoperative delirium and postoperative cognitive dysfunction are the most common complications for older surgical patients. General anesthesia may contribute to the development of these conditions, but there are little data on the association of age with cognitive recovery from anesthesia in the absence of surgery or underlying medical condition. METHODS We performed a single-center cohort study of healthy adult volunteers 40 to 80 years old (N = 71, mean age 58.5 years, and 44% women) with no underlying cognitive dysfunction. Volunteers underwent cognitive testing before and at multiple time points after 2 hours of general anesthesia consisting of propofol induction and sevoflurane maintenance, akin to a general anesthetic for a surgical procedure, although no procedure was performed. The primary outcome was time to recovery to cognitive baseline on the Postoperative Quality of Recovery Scale (PQRS) within 30 days of anesthesia. Secondary cognitive outcomes were time to recovery on in-depth neuropsychological batteries, including the National Institutes of Health Toolbox and well-validated paper-and-pencil tests. The primary hypothesis is that time to recovery of cognitive function after general anesthesia increases across decades from 40 to 80 years of age. We examined this with discrete-time logit regression (for the primary outcome) and linear mixed models for interactions of age decade with time postanesthesia (for secondary outcomes). RESULTS There was no association between age group and recovery to baseline on the PQRS; 36 of 69 (52%) recovered within 60-minute postanesthesia and 63 of 69 (91%) by day 1. Hazard ratios (95% confidence interval) for each decade compared to 40- to 49-year olds were: 50 to 59 years, 1.41 (0.50-4.03); 60 to 69 years, 1.03 (0.35-3.00); and 70 to 80 years, 0.69 (0.25-1.88). There were no significant differences between older decades relative to the 40- to 49-year reference decade in recovery to baseline on secondary cognitive measures. CONCLUSIONS Recovery of cognitive function to baseline was rapid and did not differ between age decades of participants, although the number in each decade was small. These results suggest that anesthesia alone may not be associated with cognitive recovery in healthy adults of any age decade.
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Affiliation(s)
- Mark G. Baxter
- Icahn School of Medicine at Mount Sinai, Nash Family Department of Neuroscience, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Joshua S. Mincer
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Jess W. Brallier
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Arthur Schwartz
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Helen Ahn
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Tommer Nir
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Patrick J. McCormick
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, NY
| | - Mohammed Ismail
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY
| | - Margaret Sewell
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY
| | - Heather G. Allore
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT,Yale School of Public Health, Department of Biostatistics, New Haven, CT
| | - Christine M. Ramsey
- Veterans Integrated Service Network 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA,Yale Center for Medical Informatics, New Haven, CT
| | - Mary Sano
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY,James J. Peters Veterans Administration Medical Center, Department of Psychiatry, Bronx, NY
| | - Stacie G. Deiner
- Icahn School of Medicine at Mount Sinai, Department of Anesthesiology, Perioperative & Pain Medicine, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Geriatrics and Palliative Medicine, New York, NY,Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, New York, NY
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3
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Sun JY. Anesthesia and Alzheimer's: A review. J Anaesthesiol Clin Pharmacol 2020; 36:297-302. [PMID: 33487895 PMCID: PMC7812964 DOI: 10.4103/joacp.joacp_118_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/21/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022] Open
Abstract
As early as 1955, it was Bedford who provided description of cognitive changes in elderly patients following anesthesia and surgery. Reports of individuals with catastrophic, non-stroke-related decline in cognitive functions following anesthesia and surgery lead to a perception in the lay population that anesthesia and surgery have the potential to greatly exaggerate the progression of dementia, particularly Alzheimer's disease (AD). There is a concern that anesthesia and surgery could cause irreversible impairment, leading to AD. This could also explain the accelerated decline in patients with mild cognitive impairment. We seek to explore the relevant literature to determine whether a correlation exists and then propose a possible pathophysiologic mechanism.
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Affiliation(s)
- Jeffrey Y Sun
- NYU Langone Health, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, New York, USA
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4
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Kapoor MC. Neurological dysfunction after cardiac surgery and cardiac intensive care admission: A narrative review part 1: The problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia. Ann Card Anaesth 2020; 23:383-390. [PMID: 33109792 PMCID: PMC7879912 DOI: 10.4103/aca.aca_138_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The association with cardiac surgery with cognitive decline was first reported in the 1960s after the introduction of coronary artery surgery. The incidence in cognitive decline was thought to be more after cardiac surgery, especially with the use of the cardiopulmonary bypass. Anesthesia and surgery are both associated with cognitive decline but many other factors appear to contribute its genesis. On-pump surgery, microembolization during manipulation of the heart and great vessels, temperature changes, pH changes, and altered cerebral perfusion, during cardiac surgery, have all been blamed for this. Postoperative cognitive decline is associated with poor clinical outcomes and higher mortality. Several studies have been conducted in the last decade to determine the genesis of this malady. Current evidence is absolving cardiac surgery and anesthesia to be the primary causes per se of cognitive dysfunction.
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Affiliation(s)
- Mukul C Kapoor
- Department of Anaesthesia, Max Smart Super Specialty Hospital, Saket, Delhi, India
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5
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Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: a narrative review of current clinical literature. BMC Anesthesiol 2019; 19:241. [PMID: 31881996 PMCID: PMC6933922 DOI: 10.1186/s12871-019-0903-7] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022] Open
Abstract
Background The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer’s disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.
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Affiliation(s)
- Jillian C Belrose
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Center, 339 Windermere Rd, London, ON, N6A 5A5, Canada
| | - Ruediger R Noppens
- Department of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Center, 339 Windermere Rd, London, ON, N6A 5A5, Canada.
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Joseph DJ, Liu C, Peng J, Liang G, Wei H. Isoflurane mediated neuropathological and cognitive impairments in the triple transgenic Alzheimer's mouse model are associated with hippocampal synaptic deficits in an age-dependent manner. PLoS One 2019; 14:e0223509. [PMID: 31600350 PMCID: PMC6786564 DOI: 10.1371/journal.pone.0223509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/22/2019] [Indexed: 12/17/2022] Open
Abstract
Many in vivo studies suggest that inhalational anesthetics can accelerate or prevent the progression of neuropathology and cognitive impairments in Alzheimer Disease (AD), but the synaptic mechanisms mediating these ambiguous effects are unclear. Here, we show that repeated exposures of neonatal and old triple transgenic AD (3xTg) and non-transgenic (NonTg) mice to isoflurane (Iso) distinctly increased neurodegeneration as measured by S100β levels, intracellular Aβ, Tau oligomerization, and apoptotic markers. Spatial cognition measured by reference and working memory testing in the Morris Water Maze (MWM) were altered in young NonTg and 3xTg. Field recordings in the cornu ammonis 1 (CA1) hippocampus showed that neonatal control 3xTg mice exhibited hypo-excitable synaptic transmission, reduced paired-pulse facilitation (PPF), and normal long-term potentiation (LTP) compared to NonTg controls. By contrast, the old control 3xTg mice exhibited hyper-excitable synaptic transmission, enhanced PPF, and unstable LTP compared to NonTg controls. Repeated Iso exposures reduced synaptic transmission and PPF in neonatal NonTg and old 3xTg mice. LTP was normalized in old 3xTg mice, but reduced in neonates. By contrast, LTP was reduced in old but not neonatal NonTg mice. Our results indicate that Iso-mediated neuropathologic and cognitive defects in AD mice are associated with synaptic pathologies in an age-dependent manner. Based on these findings, the extent of this association with age and, possibly, treatment paradigms warrant further study.
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Affiliation(s)
- Donald J. Joseph
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Chunxia Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Jun Peng
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Department of Anesthesiology, sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ge Liang
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Huafeng Wei
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
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Bürge M, Kratzer S, Mattusch C, Hofmann C, Kreuzer M, Parsons CG, Rammes G. The anaesthetic xenon partially restores an amyloid beta-induced impairment in murine hippocampal synaptic plasticity. Neuropharmacology 2019; 151:21-32. [PMID: 30940537 DOI: 10.1016/j.neuropharm.2019.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/15/2019] [Accepted: 03/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND It is controversially discussed whether general anaesthesia increases the risk of Alzheimer's disease (AD) or accelerates its progression. One important factor in AD pathogenesis is the accumulation of soluble amyloid beta (Aβ) oligomers which affect N-methyl-d-aspartate (NMDA) receptor function and abolish hippocampal long-term potentiation (LTP). NMDA receptor antagonists, at concentrations allowing physiological activation, can prevent Aβ-induced deficits in LTP. The anaesthetics xenon and S-ketamine both act as NMDA receptor antagonists and have been reported to be neuroprotective. In this study, we investigated the effects of subanaesthetic concentrations of these drugs on LTP deficits induced by different Aβ oligomers and compared them to the effects of radiprodil, a NMDA subunit 2B (GluN2B)-selective antagonist. METHODS We applied different Aβ oligomers to murine brain slices and recorded excitatory postsynaptic field potentials before and after high-frequency stimulation in the CA1 region of hippocampus. Radiprodil, xenon and S-ketamine were added and recordings evoked from a second input were measured. RESULTS Xenon and radiprodil, applied at low concentrations, partially restored the LTP deficit induced by pre-incubated Aβ1-42. S-ketamine showed no effect. None of the drugs tested were able to ameliorate Aβ1-40-induced LTP-deficits. CONCLUSIONS Xenon administered at subanaesthetic concentrations partially restored Aβ1-42-induced impairment of LTP, presumably via its weak NMDA receptor antagonism. The effects were in a similar range than those obtained with the NMDA-GluN2B antagonist radiprodil. Our results point to protective properties of xenon in the context of pathological distorted synaptic physiology which might be a meaningful alternative for anaesthesia in AD patients.
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Affiliation(s)
- Martina Bürge
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, United Kingdom.
| | - Stephan Kratzer
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Corinna Mattusch
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany; Hexal AG, Industriestr. 25, 83607 Holzkirchen, Germany
| | - Carolin Hofmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | - Matthias Kreuzer
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
| | | | - Gerhard Rammes
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 Munich, Germany
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Strand AK, Nyqvist F, Ekdahl A, Wingren G, Eintrei C. Is there a relationship between anaesthesia and dementia? Acta Anaesthesiol Scand 2019; 63:440-447. [PMID: 30511411 DOI: 10.1111/aas.13302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term cognitive problems are common among elderly patients after surgery, and it has been suggested that inhalation anaesthetics play a role in the development of dementia. This study aims to investigate the hypothesis that patients with dementia have been more exposed to surgery and inhalational anaesthetics than individuals without dementia. METHODS Using 457 cases from a dementia-registry and 420 dementia-free controls, we performed a retrospective case-control study. The medical records were reviewed to determine exposure to anaesthesia occurring within a 20-year timeframe before the diagnosis or inclusion in the study. Data were analysed using multivariate logistic regression and propensity score analysis. RESULTS Advanced age (70 years and older, with the highest risk in ages 80-84 years) and previous head trauma were risk factors for dementia. History of exposure to surgery with anaesthesia was a risk factor for dementia (OR = 2.23, 95% CI 1.66-3.00, P < 0.01). Exposure to inhalational anaesthetics with halogenated anaesthetics was associated with an increased risk of dementia, compared to no exposure to anaesthesia (OR = 2.47, 95% CI 1.17-5.22, P = 0.02). Exposure to regional anaesthesia was not significantly associated with increased risk of dementia (P = 0.13). CONCLUSION In this 20-year retrospective case-control study, we found a potential association between dementia and prior anaesthesia. Exposure to general anaesthetics with halogenated anaesthetic gases was associated with an increased risk of dementia.
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Affiliation(s)
- Anna-Karin Strand
- Department of Medical and Health Sciences, Division of Anaesthesia; Linköping University; Linköping Sweden
| | - Fredrik Nyqvist
- Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine, Faculty of Medicine and Health Sciences; Linköping University; Linköping Sweden
| | - Anne Ekdahl
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical geriatrics; Karolinska Institutet (KI); Helsingborg Sweden
- Department of Clinical Sciences Helsingborg; Lund University; Sweden
| | - Gun Wingren
- Department of Clinical and Experimental Medicine; Linköping University; Linkoping Sweden
| | - Christina Eintrei
- Division of Anaesthesia, Department of Medical and Health Sciences; Linköping University; Sweden
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Absence of Neuropathology With Prolonged Isoflurane Sedation in Healthy Adult Rats. J Neurosurg Anesthesiol 2018; 29:439-447. [PMID: 27653221 DOI: 10.1097/ana.0000000000000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of isoflurane sedation for prolonged periods in the critical care environment is increasing. However, isoflurane-mediated neurotoxicity has been widely reported. The goal of the present study was to determine whether long-term exposure to low-dose isoflurane in mechanically ventilated rodents is associated with evidence of neurodegeneration or neuroinflammation. METHODS Adult female Sprague-Dawley rats were used in this study. Experimental animals (n=11) were induced with 1.5% isoflurane, intubated, and given a neuromuscular blockade with α-cobratoxin. EEG electrodes were surgically implanted, subcutaneous precordial EKG Ag wire electrodes, and bladder, femoral artery, and femoral vein cannulas permanently placed. After these procedures, the isoflurane concentration was reduced to 0.5% and, in conjunction with the neuromuscular blockade, continued for 7 days. Arterial blood gases and chemistry were measured at 3 time points and core body temperature servoregulated and maintenance IV fluids were given during the 7 days. Experimental animals and untreated controls (n=9) were euthanized on day 7. RESULTS Immunohistochemical and cytochemical assays did not detect evidence of microgliosis, astrocytosis, neuronal apoptosis or necrosis, amyloidosis, or phosphorylated-tau accumulation. Blood glucose levels were significantly reduced on days 3/4 and 6/7 and partial pressure of oxygen was significantly reduced, but still within the normal range, on day 6/7. All other blood measurements were unchanged. CONCLUSIONS No neuropathologic changes consistent with neurotoxicity were detected in the brain after 1 week of continuous exposure to 0.5% isoflurane in healthy rats. These data suggest that even long exposures to low concentrations of isoflurane have no overt consequences on neuropathology.
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10
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Woodhouse A, Fernandez-Martos CM, Atkinson RAK, Hanson KA, Collins JM, O'Mara AR, Terblanche N, Skinner MW, Vickers JC, King AE. Repeat propofol anesthesia does not exacerbate plaque deposition or synapse loss in APP/PS1 Alzheimer's disease mice. BMC Anesthesiol 2018; 18:47. [PMID: 29699479 PMCID: PMC5921792 DOI: 10.1186/s12871-018-0509-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/13/2018] [Indexed: 12/14/2022] Open
Abstract
Background There is increasing interest in whether anesthetic agents affect the risk or progression of Alzheimer’s disease (AD). To mitigate many of the methodological issues encountered in human retrospective cohort studies we have used a transgenic model of AD to investigate the effect of propofol on AD pathology. Methods Six month-old amyloid precursor protein/presenilin 1 (APP/PS1) transgenic AD mice and control mice were exposed to 3 doses of propofol (200 mg/kg) or vehicle, delivered at monthly intervals. Results There was no difference in the extent of β-amyloid (Aβ) immunolabeled plaque deposition in APP/PS1 mice in vehicle versus propofol treatment groups. We also detected no difference in plaque-associated synapse loss in APP/PS1 mice following repeat propofol exposure relative to vehicle. Western blotting indicated that there was no difference in post-synaptic density protein 95, synaptophysin or glutamic acid decarboxylase 65/67 expression in control or APP/PS1 mice subjected to repeat propofol treatment relative to vehicle. Conclusions These data suggest that repeat propofol anesthesia may not exacerbate plaque deposition or associated synapse loss in AD. Interestingly, this data also provides some of the first evidence suggesting that repeat propofol exposure in adult wild-type mice does not result in robust long-term alterations in the levels of key excitatory and inhibitory synaptic markers. Electronic supplementary material The online version of this article (10.1186/s12871-018-0509-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adele Woodhouse
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia.
| | | | | | - Kelsey Anne Hanson
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Jessica Marie Collins
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Aidan Ryan O'Mara
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Nico Terblanche
- Tasmanian Health Service, Royal Hobart Hospital, Hobart, Australia.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - Marcus Welby Skinner
- Department of Health and Human Services Tasmania, Royal Hobart Hospital, Hobart, Australia.,School of Medicine, University of Tasmania, Hobart, Australia
| | - James Clement Vickers
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
| | - Anna Elizabeth King
- Wicking Dementia Research and Education Centre , University of Tasmania, Hobart, Australia
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11
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Vutskits L, Xie Z. Lasting impact of general anaesthesia on the brain: mechanisms and relevance. Nat Rev Neurosci 2017; 17:705-717. [PMID: 27752068 DOI: 10.1038/nrn.2016.128] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
General anaesthesia is usually considered to safely induce a reversible brain state allowing the performance of surgery under optimal conditions. An increasing number of clinical and experimental observations, however, suggest that anaesthetic drugs, especially when they are administered at the extremes of age, can trigger long-term morphological and functional alterations in the brain. Here, we review available mechanistic data linking general-anaesthesia exposure to impaired cognitive performance in both young and mature nervous systems. We also provide a critical appraisal of the translational value of animal models and highlight the important challenges that need to be addressed to strengthen the link between laboratory work and clinical investigations in the field of anaesthesia-neurotoxicity research.
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Affiliation(s)
- Laszlo Vutskits
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, 4 rue Gabrielle-Perret-Gentil, 1205 Geneva 4, Switzerland.,Department of Basic Neuroscience, University of Geneva Medical School, 1 rue Michel Servet, 1211 Geneva 4, Switzerland
| | - Zhongcong Xie
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Room 4310, Charlestown, Massachusetts 02129, USA
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Abstract
Over a decade ago, alarming findings were reported that exposure of the very young and very old animals to clinically used general anesthetics could be detrimental to their brains. The evidence presented suggested that the exposure to commonly used gaseous and intravenous general anesthetics induces the biochemical and morphologic changes in the immature and aging neurons ultimately resulting in their demise. More alarming was the demonstration of significant cognitive and behavioral impairments noted long after the initial anesthesia exposure. This article provides an overview of anesthesia-induced developmental neurotoxicity and commentary on the effects of general anesthesia on the aging brain.
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Affiliation(s)
- Vesna Jevtovic-Todorovic
- Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B-113, Leprino Office Building 7th Floor, 12401 East 17th Avenue, Aurora, CO 80045, USA.
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Evidence of altered age-related brain cytoarchitecture in mouse models of down syndrome: a diffusional kurtosis imaging study. Magn Reson Imaging 2014; 33:437-47. [PMID: 25527393 DOI: 10.1016/j.mri.2014.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/26/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022]
Abstract
Mouse models of Down syndrome (DS) exhibit abnormal brain developmental and neurodegenerative changes similar to those seen in individuals with DS. Although DS mice have been well characterized cognitively and morphologically there are no prior reports utilizing diffusion MRI. In this study we investigated the ability of diffusional kurtosis imaging (DKI) to detect the progressive developmental and neurodegenerative changes in the Ts65Dn (TS) DS mouse model. TS mice displayed higher diffusional kurtosis (DK) in the frontal cortex (FC) compared to normal mice at 2months of age. At 5months of age, TS mice had lower radial kurtosis in the striatum (ST), which persisted in the 8-month-old mice. The TS mice exhibited lower DK metrics values in the dorsal hippocampus (HD) at all ages, and the group difference in this region was larger at 8-months. Regression analysis showed that normal mice had a significant age-related increase in DK metrics in FC, ST and HD. On the contrary, the TS mice lacked significant age-related increase in DK metrics in FC and ST. Although preliminary, these results demonstrate that DK metrics can detect TS brain developmental and neurodegenerative abnormalities.
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Eckenhoff RG, Planel E. Anesthesia, surgery and neurodegeneration. Preface. Prog Neuropsychopharmacol Biol Psychiatry 2013; 47:121. [PMID: 24207168 DOI: 10.1016/j.pnpbp.2013.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/16/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Roderick G Eckenhoff
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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