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Ring S, Pansuriya T, Rashid H, Srinivasan A, Kesavan R, Manjunath SK, Jayaraman G, Sarva ST. Coronary Air Embolism Secondary to Percutaneous Lung Biopsy: A Systematic Review. Cureus 2024; 16:e55234. [PMID: 38558608 PMCID: PMC10981388 DOI: 10.7759/cureus.55234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
To determine mortality and morbidity associated with coronary air embolism (CAE) secondary to complications of percutaneous lung biopsy (PLB) and illicit-specific risk factor associated with this complication and overall mortality, we searched PubMed to identify reported cases of CAE secondary to PLB. After assessing inclusion eligibility, a total of 31 cases from 26 publications were included in our study. Data were analyzed using Fisher's exact test. In 31 reported cases, cardiac arrest was more common after left lower lobe (LLL) biopsies (n=4, 80%, p=0.001). Of these patients who suffered from cardiac arrest, CAE was found more frequently in the right coronary artery (RCA) than other locations but did not reach statistical significance (n=5, 62%, p=0.39). At the same time, intervention in the LLL was significantly associated with patient mortality (n=3, 60%, p=0.010). Of the patients who died, CAE was more likely to have occurred in the RCA, but this association was not statistically significant (n=4, 57%, p=0.33). LLL biopsies have a statistically significant correlation with cardiac arrest and patient death. More research is needed to examine the effect of the air location in the RCA on patient morbidity and mortality.
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Affiliation(s)
- Shai Ring
- Department of Internal Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Internal Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Tusharkumar Pansuriya
- Department of Internal Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Internal Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Hytham Rashid
- Department of Internal Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Internal Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Aswin Srinivasan
- Department of Internal Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Internal Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Ramesh Kesavan
- Department of Pulmonary and Critical Care Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Pulmonary and Critical Care Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Skantha K Manjunath
- Department of Pulmonary and Critical Care Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Pulmonary and Critical Care Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Gnananandh Jayaraman
- Department of Pulmonary and Critical Care Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Pulmonary and Critical Care Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Siva T Sarva
- Department of Pulmonary and Critical Care Medicine, HCA Houston Healthcare Kingwood, Houston, USA
- Department of Pulmonary and Critical Care Medicine, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, USA
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Hung KC, Ho CN, Liu WC, Yew M, Chang YJ, Lin YT, Hung IY, Chen JY, Huang PW, Sun CK. Prophylactic effect of intravenous lidocaine against cognitive deficit after cardiac surgery: A PRISMA-compliant meta-analysis and trial sequential analysis. Medicine (Baltimore) 2022; 101:e30476. [PMID: 36107567 PMCID: PMC9439840 DOI: 10.1097/md.0000000000030476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed at providing an updated evidence of the association between intraoperative lidocaine and risk of postcardiac surgery cognitive deficit. METHODS Randomized clinical trials (RCTs) investigating effects of intravenous lidocaine against cognitive deficit in adults undergoing cardiac surgeries were retrieved from the EMBASE, MEDLINE, Google scholar, and Cochrane controlled trials register databases from inception till May 2021. Risk of cognitive deficit was the primary endpoint, while secondary endpoints were length of stay (LOS) in intensive care unit/hospital. Impact of individual studies and cumulative evidence reliability were evaluated with sensitivity analyses and trial sequential analysis, respectively. RESULTS Six RCTs involving 963 patients published from 1999 to 2019 were included. In early postoperative period (i.e., 2 weeks), the use of intravenous lidocaine (overall incidence = 14.8%) was associated with a lower risk of cognitive deficit compared to that with placebo (overall incidence = 33.1%) (relative risk = 0.49, 95% confidence interval: 0.32-0.75). However, sensitivity analysis and trial sequential analysis signified insufficient evidence to arrive at a firm conclusion. In the late postoperative period (i.e., 6-10 weeks), perioperative intravenous lidocaine (overall incidence = 37.9%) did not reduce the risk of cognitive deficit (relative risk = 0.99, 95% confidence interval: 0.84) compared to the placebo (overall incidence = 38.6%). Intravenous lidocaine was associated with a shortened LOS in intensive care unit/hospital with weak evidence. CONCLUSION Our results indicated a prophylactic effect of intravenous lidocaine against cognitive deficit only at the early postoperative period despite insufficient evidence. Further large-scale studies are warranted to assess its use for the prevention of cognitive deficit and enhancement of recovery (e.g., LOS).
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Wei-Cheng Liu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Yao-Tsung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - I-Yin Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan city, Taiwan
| | - Ping-Wen Huang
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua city, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung city, Taiwan
- College of Medicine, I-Shou University, Kaohsiung city, Taiwan
- *Correspondence: Cheuk-Kwan Sun, Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan (e-mail: )
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Klinger RY, Cooter M, Bisanar T, Terrando N, Berger M, Podgoreanu MV, Stafford-Smith M, Newman MF, Mathew JP. Intravenous Lidocaine Does Not Improve Neurologic Outcomes after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology 2020; 130:958-970. [PMID: 30870159 DOI: 10.1097/aln.0000000000002668] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive decline after cardiac surgery occurs frequently and persists in a significant proportion of patients. Preclinical studies and human trials suggest that intravenous lidocaine may confer protection in the setting of neurologic injury. It was hypothesized that lidocaine administration would reduce cognitive decline after cardiac surgery compared to placebo. METHODS After institutional review board approval, 478 patients undergoing cardiac surgery were enrolled into this multicenter, prospective, randomized, double-blinded, placebo-controlled, parallel group trial. Subjects were randomized to lidocaine 1 mg/kg bolus after the induction of anesthesia followed by a continuous infusion (48 μg · kg · min for the first hour, 24 μg · kg · min for the second hour, and 10 μg · kg · min for the next 46 h) or saline with identical volume and rate changes to preserve blinding. Cognitive function was assessed preoperatively and at 6 weeks and 1 yr postoperatively using a standard neurocognitive test battery. The primary outcome was change in cognitive function between baseline and 6 weeks postoperatively, adjusting for age, years of education, baseline cognition, race, and procedure type. RESULTS Among the 420 allocated subjects who returned for 6-week follow-up (lidocaine: N = 211; placebo: N = 209), there was no difference in the continuous cognitive score change (adjusted mean difference [95% CI], 0.02 (-0.05, 0.08); P = 0.626). Cognitive deficit (greater than 1 SD decline in at least one cognitive domain) at 6 weeks occurred in 41% (87 of 211) in the lidocaine group versus 40% (83 of 209) in the placebo group (adjusted odds ratio [95% CI], 0.94 [0.63, 1.41]; P = 0.766). There were no differences in any quality of life outcomes between treatment groups. At the 1-yr follow-up, there continued to be no difference in cognitive score change, cognitive deficit, or quality of life. CONCLUSIONS Intravenous lidocaine administered during and after cardiac surgery did not reduce postoperative cognitive decline at 6 weeks.
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Affiliation(s)
- Rebecca Y Klinger
- From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina (R.Y.K., M.C., T.B., N.T., M.B., M.V.P., M.S.-S., J.P.M.) the Department of Anesthesiology, University of Kentucky School of Medicine, Lexington, Kentucky (M.F.N.)
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Ghannam M, Beran A, Ghazaleh D, Ferderer T, Berry B, Banna MA, Mohl L, Streib C, Thacker T, Matos I. Cerebral Air Embolism after Esophagogastroduodenoscopy: Insight on Pathophysiology, Epidemiology, Prevention and Treatment. J Stroke Cerebrovasc Dis 2019; 28:104403. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/25/2019] [Accepted: 09/08/2019] [Indexed: 12/16/2022] Open
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Lanke G, Adler DG. Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management. Ann Gastroenterol 2018; 32:156-167. [PMID: 30837788 PMCID: PMC6394273 DOI: 10.20524/aog.2018.0339] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022] Open
Abstract
Air embolism is rarely diagnosed and is often fatal. The diagnosis is often not made in a timely manner given the rapid and severe clinical deterioration that often develops, frequently leading to cardiac arrest. Many patients are only diagnosed post-mortem. With the increasing use of endoscopic retrograde cholangiopancreatography, air embolism should be considered in the differential diagnosis in patients who experience sudden clinical deterioration during or immediately after the procedure. Clinical suspicion is key in the diagnosis and management of air embolism. Use of precordial Doppler ultrasound and transesophageal echocardiogram can aid in the diagnosis of air embolism. Once the diagnosis is made, supportive management of airway, breathing and circulation is pivotal. Advanced cardiac life support should be initiated when necessary. Fluid resuscitation and vasopressors can improve cardiac output. Hyperbaric oxygen therapy should be considered when possible in cases of suspected cerebral air embolism cases to improve neurological outcome. A multidisciplinary team approach and effective communication with experts, potentially including an anesthesiologist, cardiologist, intensivist, radiologist and surgeon, can improve the outcome in air embolism.
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Affiliation(s)
- Gandhi Lanke
- Plains Regional Medical Center, Clovis, New Mexico (Gandhi Lanke), USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Douglas G. Adler), USA
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Casoni D, Mirra A, Goepfert C, Petruccione I, Spadavecchia C. Iatrogenic cerebral arterial gas embolism from flushing of the arterial line in two calves. Acta Vet Scand 2018; 60:51. [PMID: 30189865 PMCID: PMC6127953 DOI: 10.1186/s13028-018-0405-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 08/25/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Measurement of invasive blood pressure as reflection of blood flow and tissue perfusion is often carried out in animals during general anesthesia. Intravascular cannulation offers the potential for gas to directly enter the circulation and lead to arterial gas embolism. Cerebral arterial gas embolism may cause a spectrum of adverse effects ranging from very mild symptoms to severe neurological injury and death. Although several experimental models of arterial gas embolism have been published, there are no known published reports of accidental iatrogenic cerebral arterial gas embolism from flushing of an arterial line in animals. CASE PRESENTATION A 7-day-old Red Holstein-Friesian calf (No. 1) and a 28-day-old Holstein-Friesian calf (No. 2) underwent hot iron disbudding and sham disbudding, respectively, under sedation and cornual nerve anesthesia. Invasive arterial blood pressure was measured throughout the procedure and at regular intervals during the day. Before disbudding, a sudden and severe increase of blood pressure was observed following flushing of the arterial line. Excitation, hyperextension of the limbs and rapid severe horizontal nystagmus appeared shortly thereafter. Over the following minutes, symptoms ameliorated and blood pressure normalized in both cases. Prompt diagnosis was missed in calf 1; supportive fluid therapy was provided. Severe deterioration of neurologic status occurred in the following 24 h and culminated with stupor. The calf was euthanized for ethical reasons and the histological examination revealed extensive cerebral injury. Treatment of calf 2 consisted of supportive fluid and oxygen therapy; furosemide (1 mg/kg IV) was injected twice. Calf 2 appeared clinically normal after 2 h and showed no neurologic sequelae on a 3-month-follow up period. CONCLUSIONS There are no known reports of cerebral arterial gas embolism following flushing of the auricular arterial line in calves. The injection of a small amount of air at high pressure in a peripheral artery may lead to a significant cerebral insult. The clinical presentation is non-specific and can favour misdiagnosis and delay of therapy.
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Brull SJ, Prielipp RC. Vascular air embolism: A silent hazard to patient safety. J Crit Care 2017; 42:255-263. [PMID: 28802790 DOI: 10.1016/j.jcrc.2017.08.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/02/2017] [Accepted: 08/05/2017] [Indexed: 02/08/2023]
Abstract
PURPOSE To narratively review published information on prevention, detection, pathophysiology, and appropriate treatment of vascular air embolism (VAE). MATERIALS AND METHODS MEDLINE, SCOPUS, Cochrane Central Register and Google Scholar databases were searched for data published through October 2016. The Manufacturer and User Facility Device Experience (MAUDE) database was queried for "air embolism" reports (years 2011-2016). RESULTS VAE may be introduced through disruption in the integrity of the venous circulation that occurs during insertion, maintenance, or removal of intravenous or central venous catheters. VAE impacts pulmonary circulation, respiratory and cardiac function, systemic inflammation and coagulation, often with serious or fatal consequences. When VAE enters arterial circulation, air emboli affect cerebral blood flow and the central nervous system. New medical devices remove air from intravenous infusions. Early recognition and treatment reduce the clinical sequelae of VAE. An organized team approach to treatment including clinical simulation can facilitate preparedness for VAE. The MAUDE database included 416 injuries and 95 fatalities from VAE. Data from the American Society of Anesthesiologists Closed Claims Project showed 100% of claims for VAE resulted in a median payment of $325,000. CONCLUSIONS VAE is an important and underappreciated complication of surgery, anesthesia and medical procedures.
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Affiliation(s)
- Sorin J Brull
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, FL 32224, USA.
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN 55455, USA
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Tan VH, Chin K, Kumar A, Chng J, Soh CRSR. Treatment preferences for decompression illness amongst Singapore dive physicians. Diving Hyperb Med 2017. [PMID: 28641324 DOI: 10.28920/dhm47.2.118-122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Owing to the scarcity of randomized controlled trials to guide treatment for decompression illness (DCI), there are many unanswered questions about its management. Apart from reviews and expert opinion, surveys that report practice patterns provide information about useful management strategies. Hence, this study aimed to identify current treatment preferences for DCI amongst diving physicians in Singapore. METHODS An anonymous web-based questionnaire was sent to known diving physicians in Singapore. The demographics of the respondents were captured. Respondents were asked about their preferred management for five different DCI scenarios. RESULTS The response rate was 74% (17 of 23 responses). All respondents chose to recompress patients described in the five scenarios. Regarding the number of recompression sessions, "one additional session after no further improvement in signs and symptoms" was the most common end point of treatment across all the scenarios (47 of 85 responses). Analgesics would be used by five physicians, three would use lidocaine and two steroids as adjuvant therapies. CONCLUSIONS Apart from the general agreement that recompression is indicated for DCI, there was no strong consensus regarding other aspects of management. This survey reinforces the need for robust RCTs to validate the existing recommendations for DCI treatment.
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Affiliation(s)
- Valerie Huali Tan
- Hyperbaric and Diving Medicine Centre, 16 College Road, Block 4, Level 1, Singapore General Hospital, Singapore 169854,
| | - Kenneth Chin
- Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Aravin Kumar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremiah Chng
- Hyperbaric Medicine Section, Navy Medical Service, Republic of Singapore Navy, Singapore
| | - Chai Rick Soh Rick Soh
- Surgical Intensive Care Unit, Hyperbaric and Diving Medicine Centre, Singapore General Hospital
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Abstract
Exposure to the underwater environment is associated with several unique disorders that may require recompression in a hyperbaric chamber. Increasing pressure during descent reduces the volume of the paranasal sinuses and middle ear, which, if not properly equalized, will sustain injury due to barotrauma. Barotrauma of the inner ear results in vertigo, tinnitus, and often permanent hearing loss. During ascent, expanding gas can produce lung injury accompanied by pneumothorax, mediastinal and subcutaneous emphysema, injection of air into the pulmonary veins, and arterial air embolism to the brain. Divers with pulmonary barotrauma often present with unconsciousness, seizures, or other evidence of cerebral dysfunction. Rapid treatment with recompression often reverses the cerebral deficits. Air embolism lesions are usually diffuse, in contradistinction to a stroke which usually follows the distribution of a single cerebral artery. Decompression sickness is a disorder caused by evolution of supersaturated dissolved gas in tissues and blood following exposure to increased pressure. Protocols for avoiding excess supersaturation during ascent from depth have been available for more than 100 years, and diving is considered safe when established decompression schedules are followed. Decompression sickness causes pain in the joints of the upper and lower extremities, and can injure the spinal cord. Paralysis, paresthesias, sensory loss, and bowel and bladder paralysis accompany spinal cord injury. Treatment involves recompression and oxygen. Platelet inhibitors and other anti-inflammatory drugs are also useful. A diving disorder must be considered in any patient with a neurologic syndrome, vertigo, hearing loss, or joint pain following diving.
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Affiliation(s)
- Alfred A. Bove
- Section of Cardiology, Temple University Medical School, Philadelphia, PA,
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Bello S, Krogsbøll LT, Gruber J, Zhao ZJ, Fischer D, Hróbjartsson A. Lack of blinding of outcome assessors in animal model experiments implies risk of observer bias. J Clin Epidemiol 2014; 67:973-83. [PMID: 24972762 DOI: 10.1016/j.jclinepi.2014.04.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 03/28/2014] [Accepted: 04/04/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To examine the impact of not blinding outcome assessors on estimates of intervention effects in animal experiments modeling human clinical conditions. STUDY DESIGN AND SETTING We searched PubMed, Biosis, Google Scholar, and HighWire Press and included animal model experiments with both blinded and nonblinded outcome assessors. For each experiment, we calculated the ratio of odds ratios (ROR), that is, the odds ratio (OR) from nonblinded assessments relative to the corresponding OR from blinded assessments. We standardized the ORs according to the experimental hypothesis, such that an ROR <1 indicates that nonblinded assessor exaggerated intervention effect, that is, exaggerated benefit in experiments investigating possible benefit or exaggerated harm in experiments investigating possible harm. We pooled RORs with inverse variance random-effects meta-analysis. RESULTS We included 10 (2,450 animals) experiments in the main meta-analysis. Outcomes were subjective in most experiments. The pooled ROR was 0.41 (95% confidence interval [CI], 0.20, 0.82; I(2) = 75%; P < 0.001), indicating an average exaggeration of the nonblinded ORs by 59%. The heterogeneity was quantitative and caused by three pesticides experiments with very large observer bias, pooled ROR was 0.20 (95% CI, 0.07, 0.59) in contrast to the pooled ROR in the other seven experiments, 0.82 (95% CI, 0.57, 1.17). CONCLUSION Lack of blinding of outcome assessors in animal model experiments with subjective outcomes implies a considerable risk of observer bias.
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Affiliation(s)
- Segun Bello
- The Nordic Cochrane Centre, Rigshospitalet, Department 7811, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
| | - Lasse T Krogsbøll
- The Nordic Cochrane Centre, Rigshospitalet, Department 7811, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jan Gruber
- Department of Biochemistry, Neurobiology and Ageing Programme, Centre for Life Sciences (CeLS), National University of Singapore, 28 Medical Drive, #04-21 Lab 2, 117456, Singapore
| | - Zhizhuang J Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center 940, Stanton L. Young Blvd., BMSB 451, Oklahoma City, Oklahoma 73104, USA
| | - Doris Fischer
- Department of Pediatrics, Division of Neonatology, J.W. Goethe - University Hospital Theodor Stern Kai 7, 60590, Frankfurt, Germany
| | - Asbjørn Hróbjartsson
- The Nordic Cochrane Centre, Rigshospitalet, Department 7811, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Naito H, Takeda Y, Danura T, Kass IS, Morita K. Effect of lidocaine on dynamic changes in cortical reduced nicotinamide adenine dinucleotide fluorescence during transient focal cerebral ischemia in rats. Neuroscience 2013; 235:59-69. [PMID: 23321540 DOI: 10.1016/j.neuroscience.2013.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/27/2012] [Accepted: 01/08/2013] [Indexed: 01/24/2023]
Abstract
Rats were subjected to 90min of focal ischemia by occluding the left middle cerebral and both common carotid arteries. The dynamic changes in the formation of brain ischemic areas were analyzed by measuring the direct current (DC) potential and reduced nicotinamide adenine dinucleotide (NADH) fluorescence with ultraviolet irradiation. In the lidocaine group (n=10), 30min before ischemia, an intravenous bolus (1.5mg/kg) of lidocaine was administered, followed by a continuous infusion (2mg/kg/h) for 150min. In the control group (n=10), an equivalent amount of saline was administered. Following the initiation of ischemia, an area of high-intensity NADH fluorescence rapidly developed in the middle cerebral artery territory in both groups and the DC potential in this area showed ischemic depolarization. An increase in NADH fluorescence closely correlated with the DC depolarization. The blood flow in the marginal zone of both groups showed a similar decrease. Five minutes after the onset of ischemia, the area of high-intensity NADH fluorescence was significantly smaller in the lidocaine group (67% of the control; P=0.01). This was likely due to the suppression of ischemic depolarization by blockage of voltage-dependent sodium channels with lidocaine. Although lidocaine administration did not attenuate the number of peri-infarct depolarizations during ischemia, the high-intensity area and infarct volume were significantly smaller in the lidocaine group both at the end of ischemia (78% of the control; P=0.046) and 24h later (P=0.02). A logistic regression analysis demonstrated a relationship between the duration of ischemic depolarization and histologic damage and revealed that lidocaine administration did not attenuate neuronal damage when the duration of depolarization was identical. These findings indicate that the mechanism by which lidocaine decreases infarct volume is primarily through a reduction of the brain area undergoing NADH fluorescence increases which closely correlates with depolarization.
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Affiliation(s)
- H Naito
- Department of Anesthesiology, Okayama University Medical School, Japan
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Weenink RP, Hollmann MW, van Hulst RA. Animal models of cerebral arterial gas embolism. J Neurosci Methods 2012; 205:233-45. [PMID: 22281296 DOI: 10.1016/j.jneumeth.2011.12.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 12/21/2022]
Abstract
Cerebral arterial gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral arterial gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties discussed are species, cerebrovascular anatomy, method of air embolization, amount of air, bubble size, outcome parameters, anesthesia, blood glucose, body temperature and blood pressure.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Centre, Royal Netherlands Navy, Den Helder, The Netherlands.
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Weenink RP, Hollmann MW, Stevens MF, van Lienden KP, Ghazi-Hosseini E, van Gulik TM, van Hulst RA. Cerebral arterial gas embolism in swine. Comparison of two sites for air injection. J Neurosci Methods 2010; 194:336-41. [PMID: 21074559 DOI: 10.1016/j.jneumeth.2010.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
Abstract
Cerebral arterial gas embolism is a risk in diving and occurs as a complication in surgery and interventional radiology. Swine models for cerebral arterial gas embolism have been used in the past. However, injection of air into the main artery feeding the pig brain - the ascending pharyngeal artery - might be complicated by the presence of the carotid rete, an arteriolar network at the base of the brain. On the other hand, anastomoses between external and internal carotid territories are present in the pig. In order to determine the most appropriate vessel for air injection, we performed experiments in which air was injected into either the ascending pharyngeal artery or the external carotid artery. We injected 0.25 ml/kg of room air selectively into the ascending pharyngeal artery or the external carotid artery of 35-40 kg Landrace pigs (n=8). We assessed the effect on cerebral metabolism by measuring intracranial pressure, brain oxygen tension and brain glucose and lactate concentrations using cerebral microdialysis. Intracranial pressure and brain oxygen tension changed significantly in both groups, but did not differ between groups. Brain lactate increased significantly more in pigs in which air was injected into the ascending pharyngeal artery. Intracranial pressure, brain oxygen tension and brain lactate correlated after injection of air into the ascending pharyngeal artery, but not after injection into the external carotid artery. Our model is suitable for investigation of cerebral arterial gas embolism. The ascending pharyngeal artery is the most appropriate vessel for air injection.
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Affiliation(s)
- Robert P Weenink
- Diving Medical Center, Royal Netherlands Navy, PO Box 10000, 1780 CA, Den Helder, The Netherlands.
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Mathew JP, Mackensen GB, Phillips-Bute B, Grocott HP, Glower DD, Laskowitz DT, Blumenthal JA, Newman MF. Randomized, double-blinded, placebo controlled study of neuroprotection with lidocaine in cardiac surgery. Stroke 2009; 40:880-7. [PMID: 19164788 DOI: 10.1161/strokeaha.108.531236] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive decline after cardiac surgery remains common and diminishes patients' quality of life. Based on experimental and clinical evidence, this study assessed the potential of intravenously administered lidocaine to reduce postoperative cognitive dysfunction after cardiac surgery using cardiopulmonary bypass. METHODS After IRB approval, 277 patients undergoing cardiac surgery were enrolled into this prospective, randomized, double-blinded placebo controlled clinical trial. Subjects were randomized to receive: (1) Lidocaine as a 1 mg/kg bolus followed by a continuous infusion through 48 hours postoperatively, or (2) Placebo bolus and infusion. Cognitive function was assessed preoperatively and again at 6 weeks and 1 year postoperatively. The effect of lidocaine on postoperative cognition was tested using multivariable regression modeling; P<0.05 was considered significant. RESULTS Among the 241 allocated subjects (Lidocaine: n=114; Placebo: n=127), the incidence of cognitive deficit in the lidocaine group was 45.5% versus 45.7% in the placebo group (P=0.97). Multivariable analysis revealed a significant interaction between treatment group and diabetes, such that diabetic subjects receiving lidocaine were more likely to suffer cognitive decline (P=0.004). Secondary analysis identified total lidocaine dose (mg/kg) as a significant predictor of cognitive decline and also revealed a protective effect of lower dose lidocaine in nondiabetic subjects. CONCLUSIONS Lidocaine administered during and after cardiac surgery does not reduce the high rate of postoperative cognitive dysfunction. Higher doses of lidocaine and diabetic status were independent predictors of cognitive decline. Protective effects of lower dose lidocaine in nondiabetic subjects need to be further evaluated.
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Affiliation(s)
- Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
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15
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Barak M, Nakhoul F, Katz Y. Reviews: Pathophysiology and Clinical Implications of Microbubbles during Hemodialysis. Semin Dial 2008; 21:232-8. [DOI: 10.1111/j.1525-139x.2008.00424.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Ruest P, Aroichane M, Cordahi G, Bureau N. Possible venous air embolism during open eye surgery in a child. Can J Anaesth 2007; 54:840-4. [DOI: 10.1007/bf03021713] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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17
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Abstract
Gas embolism is a known complication of various invasive procedures, and its management is well established. The consequence of gas microemboli, microbubbles, is underrecognized and usually overlooked in daily practice. We present the current data regarding the pathophysiology of microemboli and their clinical consequences. Microbubbles originate mainly in extracorporeal lines and devices, such as cardiopulmonary bypass and dialysis machines, but may be endogenous in cases of decompression sickness or mechanical heart valves. Circulating in the blood stream, microbubbles lodge in the capillary bed of various organs, mainly the lungs. The microbubble obstructs blood flow in the capillary, thus causing tissue ischemia, followed by inflammatory response and complement activation. Aggregation of platelets and clot formation occurs as well, leading to further obstruction of microcirculation and tissue damage. In this review, we present evidence of the biological and clinical detrimental effects of microbubbles as demonstrated by studies in animal models and humans, and discuss management of the microbubble problem with regard to detection, prevention, and treatment.
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Affiliation(s)
- Michal Barak
- Department of Anesthesiology, Rambam Medical Center, Haifa, Israel
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18
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Schröder S, Lier H, Wiese S. [Diving accidents. Emergency treatment of serious diving accidents]. Anaesthesist 2005; 53:1093-102. [PMID: 15565421 DOI: 10.1007/s00101-004-0748-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Decompression injuries are potentially life-threatening incidents mainly due to a rapid decline in ambient pressure. Decompression illness (DCI) results from the presence of gas bubbles in the blood and tissue. DCI may be classified as decompression sickness (DCS) generated from the liberation of gas bubbles following an oversaturation of tissues with inert gas and arterial gas embolism (AGE) mainly due to pulmonary barotrauma. People working under hyperbaric pressure, e.g. in a caisson for general construction under water, and scuba divers are exposed to certain risks. Diving accidents can be fatal and are often characterized by organ dysfunction, especially neurological deficits. They have become comparatively rare among professional divers and workers. However, since recreational scuba diving is gaining more and more popularity there is an increasing likelihood of severe diving accidents. Thus, emergency staff working close to areas with a high scuba diving activity, e.g. lakes or rivers, may be called more frequently to a scuba diving accident. The correct and professional emergency treatment on site, especially the immediate and continuous administration of normobaric oxygen, is decisive for the outcome of the accident victim. The definitive treatment includes rapid recompression with hyperbaric oxygen. The value of adjunctive medication, however, remains controversial.
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Affiliation(s)
- S Schröder
- Klinik für Anästhesie und Intensivmedizin, Westküstenklinikum Heide.
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19
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Tetzlaff K, Shank ES, Muth CM. Evaluation and management of decompression illness--an intensivist's perspective. Intensive Care Med 2003; 29:2128-2136. [PMID: 14600806 DOI: 10.1007/s00134-003-1999-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2003] [Accepted: 08/11/2003] [Indexed: 11/25/2022]
Abstract
Decompression illness (DCI) is becoming more prevalent as more people engage in activities involving extreme pressure environments such as recreational scuba-diving. Rapid diagnosis and treatment offer these patients the best chance of survival with minimal sequelae. It is thus important that critical care physicians are able to evaluate and diagnose the signs and symptoms of DCI. The cornerstones of current treatment include the administration of hyperbaric oxygen and adjunctive therapies such as hydration and medications. However, managing patients in a hyperbaric environment does present additional challenges with respect to the particular demands of critical care medicine in an altered pressure environment. This article reviews the underlying pathophysiology, clinical presentation and therapeutic options available to treat DCI, from the intensivist's perspective.
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Affiliation(s)
- Kay Tetzlaff
- 1st Department of Medicine, Christian-Albrechts-University of Kiel, Schittenhelmstrasse 12, 24105, Kiel, Germany.
- Clinical Research (Respiratory), Boehringer Ingelheim Pharma GmbH & Co. KG, 88397 , Biberach an der Riss, Germany.
| | - Erik S Shank
- Department of Anaesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Claus M Muth
- Department of Anaesthesiology, Section of Pathophysiology and Process Development, University of Ulm, Parkstrasse 11, 89073 , Ulm, Germany
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20
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Wherrett CG, Mehran RJ, Beaulieu MA. Cerebral arterial gas embolism following diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen. Can J Anaesth 2002; 49:96-9. [PMID: 11782337 DOI: 10.1007/bf03020427] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To describe a clinical scenario consistent with the diagnosis of cerebral arterial gas embolism (CAGE) acquired during an outpatient bronchoscopy. Our discussion explores the mechanisms and diagnosis of CAGE and the role of hyperbaric oxygen therapy. CLINICAL FEATURES A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for bronchogenic carcinoma three months earlier. During the direct insufflation of oxygen into the right middle lobe bronchus, the patient became unresponsive and developed subcutaneous emphysema. Immediately, an endotracheal tube and bilateral chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to pain. Later, in the intensive care unit, he exhibited seizure activity requiring anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of barotrauma, and an abnormal electroencephalogram. Fifty-two hours after the event, he was treated for presumed CAGE with hyperbaric oxygen using a modified United States Navy Table 6. Twelve hours later he had regained consciousness and was extubated. He underwent two more hyperbaric treatments and was discharged from hospital one week after the event, fully recovered. CONCLUSION A patient with presumed CAGE made a complete recovery following treatment with hyperbaric oxygen therapy even though it was initiated after a significant time delay.
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Affiliation(s)
- Chris G Wherrett
- Department of Anesthesiology, Ottawa Hospital Hyperbaric Unit, Ottawa, Ontario, Canada.
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21
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Shank ES, Muth CM. Decompression illness, iatrogenic gas embolism, and carbon monoxide poisoning: the role of hyperbaric oxygen therapy. Int Anesthesiol Clin 2000; 38:111-38. [PMID: 10723672 DOI: 10.1097/00004311-200001000-00008] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E S Shank
- Division of Hyperbaric Medicine, Massachusetts Eye and Ear Institute, Massachusetts General Hospital, Boston 02114, USA
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22
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Mitchell SJ, Benson M, Vadlamudi L, Miller P. Cerebral arterial gas embolism by helium: an unusual case successfully treated with hyperbaric oxygen and lidocaine. Ann Emerg Med 2000; 35:300-3. [PMID: 10692202 DOI: 10.1016/s0196-0644(00)70086-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 27-year-old man inhaled helium from an unregulated pressurized cylinder and underwent cerebral arterial gas embolism (CAGE), leaving him blind and with radiologic evidence initially suggesting cortical infarction. There was complete recovery of vision and substantial regression of the radiologic changes after 4 hyperbaric oxygen treatments and a 54-hour lidocaine infusion, which began 6 hours after the accident. This is the second reported case of CAGE occurring by this mechanism and the first case of unequivocal CAGE in which lidocaine has been used as an adjunctive treatment with hyperbaric oxygen.
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Affiliation(s)
- S J Mitchell
- Wesley Centre for Hyperbaric Medicine, Brisbane, Australia.
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23
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Affiliation(s)
- C M Muth
- Druckkammerzentrum Homburg, University Hospital Homburg, University of the Saarland, Homburg/Saar, Germany.
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24
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Abstract
Recognition of condition attributable to the environmental changes experienced by divers will facilitate appropriate treatment. The diagnosis of these conditions rarely requires sophisticated imaging or electrophysiologic testing. Divers who have suspected DCI, in addition to general supportive measures, should be administered fluids and oxygen and transported to a recompression chamber. For diving-related conditions, on-line consultation is available from the Divers Alert Network, Durham, NC (919-684-8111).
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Affiliation(s)
- R E Moon
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
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25
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Tovar EA, Del Campo C, Borsari A, Webb RP, Dell JR, Weinstein PB. Postoperative management of cerebral air embolism: gas physiology for surgeons. Ann Thorac Surg 1995; 60:1138-42. [PMID: 7574975 DOI: 10.1016/0003-4975(95)00531-o] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cerebral gaseous microemboli are present in most, if not all, cardiopulmonary bypass-assisted operations. Fortunately, the great majority are subclinical. Clinically significant cases of cerebral air embolism are largely underdiagnosed, undertreated, and underreported. The management of cerebral air embolism has been challenged due to the lack of prospective, randomized studies. Preventive measures that have been implemented throughout the years, resulting from empirically acquired knowledge, have avoided frequent major mishaps. Perfusion accidents, in which massive amounts of gas are pumped into patients, are managed intraoperatively by common-sense heroic measures which, at best, remove 50% of the embolized gas. Postoperative confirmation of a neurologic insult after a cardiopulmonary bypass-assisted operation, in which a cerebral air embolism is likely the source, is one of the most distressing situations a surgical team has to confront, due in part to the lack of pathognomonic diagnostic tools and to the absence of a "scientifically proven" (supported by prospective, randomized studies) therapeutic regimen. In lieu of the latter, we present the physical and physiologic bases that will justify the use of several therapeutic tools when facing a suspected CAE. These tools, when applied rationally, will represent some of the most innocuous modalities in the medical armamentarium.
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Affiliation(s)
- E A Tovar
- Division of Cardiovascular Surgery, St. Jude Medical Center, Fullerton, California, USA
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26
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Abstract
Irreversible anoxic injury is dependent on extracellular Ca2+ in mammalian CNS white matter, with a large portion of the pathologic Ca2+ influx occurring through reverse Na(+)-Ca2+ exchange, stimulated by increased intracellular [Na+]. This Na+ leak likely occurs via incompletely inactivated voltage-gated Na+ channels. This study reports that clinically used antiarrhythmic compounds, likely by virtue of their Na+ channel-blocking properties, significantly protect CNS white matter from anoxia at concentrations that cause little suppression of the preanoxic response. Rat optic nerves were pretreated with various agents for 60 min, then subjected to 60 min of anoxia in vitro. Functional recovery was measured electrophysiologically as the area under the compound action potential (CAP). Without drug, the CAP areas recovered to a mean of 32 +/- 12% of control after 1 h of reoxygenation. Recoveries using prajmaline 10 microM were 82 +/- 15% (p < 0.0001), and using tocainide 1 mM, 78 +/- 8% (p < 0.0001), with little suppression (< or = 10%) of the preanoxic response. Ajmaline (10-100 microM), disopyramide (10-300 microM) and bupivacaine (10-100 microM) were somewhat less effective, whereas verapamil produced 52 +/- 11% recovery before reduction of the preanoxic CAP was observed at 30 microM. Procainamide (100-300 microM) was ineffective. These results suggest that Na+ channel blockers, including commonly used antiarrhythmic agents, may be effective in protecting central white matter, which is a target for anoxic/ischemic injury in diseases such as stroke and spinal cord injury.
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Affiliation(s)
- P K Stys
- Loeb Research Institute, Neuroscience Division, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada
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27
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Muir JK, Lyeth BG, Hamm RJ, Ellis EF. The effect of acute cocaine or lidocaine on behavioral function following fluid percussion brain injury in rats. J Neurotrauma 1995; 12:87-97. [PMID: 7783235 DOI: 10.1089/neu.1995.12.87] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
One of the goals of our laboratory is to examine how the presence of drugs of abuse will influence traumatic brain injury. Previous studies in our laboratory have shown that cocaine or lidocaine treatment before experimental fluid percussion brain injury in rats reduces the cortical hypoperfusion normally found in the early posttraumatic period. The purpose of the current study was to determine if pretreatment with cocaine or lidocaine is also associated with changes in trauma-induced suppression of reflexes and motor and cognitive dysfunction that occurs following traumatic brain injury (TBI). Twenty-four hours after surgical preparation, rats were randomly assigned to a saline or drug pretreatment group, cocaine (0.5, 2, or 5 mg/kg) or lidocaine (2 mg/kg), which was injected via the tail vein. None of the drug pretreatments worsened injury. Lidocaine and cocaine decreased the duration of suppression of some neurological reflexes and reduced posttraumatic body weight losses. Lidocaine and cocaine both decreased postinjury motor deficits. Lidocaine and cocaine did not affect cognitive function on days 11-15 postinjury. The mechanism by which lidocaine improves acute neurological and motor function following brain injury is unknown, but may involve improved posttraumatic cortical blood flow, as seen in our previous study. Our results, along with other studies showing lidocaine to be neuroprotective in animal models of ischemia, suggest that studies of the effect of posttraumatic administration of lidocaine are warranted.
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Affiliation(s)
- J K Muir
- Department of Pharmacology and Toxicology, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA
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28
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Isozumi K, Fukuuchi Y, Takeda H, Itoh Y. Cerebral ischemia-induced amplification phenomenon of somatosensory evoked potentials in cats. Neurosci Lett 1994; 169:203-6. [PMID: 8047283 DOI: 10.1016/0304-3940(94)90392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We elucidate the amplification phenomenon of median nerve somatosensory evoked potentials (SEPs) induced in cats by cerebral ischemia and also analyse the relationship between such amplification and cerebral blood flow (CBF). Transient focal cerebral ischemia was carried out by inducing only middle cerebral artery occlusion or jointly with bilateral common carotid artery occlusion. Various SEP alteration patterns were observed with CBF changes; with our overall results suggesting for the first time that the SEP amplification phenomenon occurs only under relatively mild cerebral ischemia.
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Affiliation(s)
- K Isozumi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
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29
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Dormehl IC, Lipp MD, Hugo N, Daublaender M, Picard JA. Influence of intravenously administered lidocaine on cerebral blood flow in a baboon model standardized under controlled general anaesthesia using single-photon emission tomography and technetium-99m hexamethylpropylene amine oxime. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1993; 20:1095-8. [PMID: 8287877 DOI: 10.1007/bf00173489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The baboon under general anaesthesia as a model to assess drug-induced cerebral blood flow changes (delta CBF) using single-photon emission tomography (SPET) offers great in vivo possibilities but has to comply with demands on control of anaesthesia-related influencing factors, such as PaCO2 changes. The model sought in this study and described here allows control of PaCO2, in the baboon under thiopentone anaesthesia by ventilation, and was evaluated for the functional dependence of delta CBF vs delta PaCO2, using SPET technetium-99m hexamethylpropylene amine oxime (HMPAO) and the split-dose method together with controlled ventilation. During the experiment the model was validated for normal reactivity to PaCO2 changes, and subsequently applied to investigate the mechanisms (still uncertain) of CBF increase known to follow administration of the local anaesthetic lidocaine. Six baboons received 6 mg/kg lidocaine intravenously. CBF was measured between two consecutive SPET acquisitions (split-dose method) respectively relating to HM-PAO distributions in the brain before and after the injection of lidocaine. Meanwhile the animals were maintained at constant respiratory rate and volume. The results indicate that the correlation between delta CBF and the ensuing fall in PaCO2 deviated from the baseline pattern from the model and confirmed a cerebrovascular contribution to the lidocaine-induced CBF increase. This agreed well with mean and systolic blood pressure changes and heart rate.
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Affiliation(s)
- I C Dormehl
- AEC Institute for Life Sciences, University of Pretoria, South Africa
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