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Liang L, Xiao L, Yu Z, Liu J. Hexafluoro-2-propanol (HFIP) decreased LPS-induced inflammatory response of Human microvascular endothelial cells. Asian J Surg 2024:S1015-9584(24)00739-5. [PMID: 38653697 DOI: 10.1016/j.asjsur.2024.04.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Affiliation(s)
- Lei Liang
- Department of Anesthesiology, Zhoushan Women and Children Hospital, Zhoushan, Zhejiang Province, China
| | - Liang Xiao
- Department of Surgery and Oncology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China
| | - Ze Yu
- Laboratory of Cytobiology & Molecular Biology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, Zhejiang Province, China.
| | - Jia Liu
- School of Agriculture, Sun Yat-sen University, Shenzhen, Guangdong Province, China; Shenzhen Zhongjia Bio-medical Technology Co., LTD, Shenzhen, Guangdong Province, China.
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2
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Roth Z'graggen B, Urner M, Beck-Schimmer B, Schläpfer M. Effects of sevoflurane and its metabolite hexafluoroisopropanol on hypoxia/reoxygenation-induced injury and mitochondrial bioenergetics in murine cardiomyocytes. BJA OPEN 2023; 5:100116. [PMID: 37587996 PMCID: PMC10430838 DOI: 10.1016/j.bjao.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/22/2022] [Indexed: 08/18/2023]
Abstract
Background The volatile anaesthetic sevoflurane protects cardiac tissue from reoxygenation/reperfusion. Mitochondria play an essential role in conditioning. We aimed to investigate how sevoflurane and its primary metabolite hexafluoroisopropanol (HFIP) affect necrosis, apoptosis, and reactive oxygen species formation in cardiomyocytes upon hypoxia/reoxygenation injury. Moreover, we aimed to describe the similarities in the mode of action in a mitochondrial bioenergetics analysis. Methods Murine cardiomyocytes were exposed to hypoxia (0.2% O2 for 6 h), followed by reoxygenation (air with 5% CO2 for 2 h) in the presence or absence sevoflurane 2.2% or HFIP 4 mM. Lactate dehydrogenase (LDH) release (necrosis), caspase activation (apoptosis), reactive oxygen species, mitochondrial membrane potential, and mitochondrial function (Seahorse XF analyser) were measured. Results Hypoxia/reoxygenation increased cell death by 44% (+31 to +55%, P<0.001). Reoxygenation in the presence of sevoflurane 2.2% or HFIP 4 mM increased LDH release only by +18% (+6 to +30%) and 20% (+7 to +32%), respectively. Apoptosis and reactive oxygen species formation were attenuated by sevoflurane and HFIP. Mitochondrial bioenergetics analysis of the two substances was profoundly different. Sevoflurane did not influence oxygen consumption rate (OCR) or extracellular acidification rate (ECAR), whereas HFIP reduced OCR and increased ECAR, an effect similar to oligomycin, an adenosine triphosphate (ATP) synthase inhibitor. When blocking the metabolism of sevoflurane into HFIP, protective effects of sevoflurane - but not of HFIP - on LDH release and caspase were mitigated. Conclusion Together, our data suggest that sevoflurane metabolism into HFIP plays an essential role in cardiomyocyte postconditioning after hypoxia/reoxygenation injury.
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Affiliation(s)
| | - Martin Urner
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Interdepartmental Division of Critical Care Medicine and University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Beatrice Beck-Schimmer
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Schläpfer
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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3
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Vintimilla Moscoso A, Figueira ERR, Rocha‐Filho JA, Urner M, Lanchotte C, Jukemura J, Ximenes JLS, Nahas SC, D'Albuquerque LAC, Galvao FHF. Hexafluoroisopropanol decreases liver ischemia-reperfusion injury by downregulation of high mobility group box-1 protein. Pharmacol Res Perspect 2022; 10:e01027. [PMID: 36404629 PMCID: PMC9676687 DOI: 10.1002/prp2.1027] [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] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/22/2022] [Accepted: 10/13/2022] [Indexed: 11/22/2022] Open
Abstract
Liver ischemia-reperfusion (IR) injury is associated with poor outcome after liver transplantation and liver resections. Hexafluoroisopropanol (HFIP) is a tri-fluorinated metabolites of volatile anesthetics and has modulatory effects on inflammation that have been observed mainly in cell culture experiments. In this survey, we investigated the effects of HFIP in a rat model of normothermic hepatic ischemia-reperfusion injury. Twenty-four male Wistar rats were randomized into three groups: (1) control in which animals were submitted to 30 min of partial liver ischemia with resection of non-ischemic liver lobes immediate after reperfusion, (2) pre-ischemia (PI) group in which animals received intravenous HFIP (67 mg/kg) 5 min before liver ischemia, and (3) pre-reperfusion (PR) group in which animals received intravenous HFIP (67 mg/kg) 5 min before reperfusion. Four hours after reperfusion, all animals were euthanized for sample collection. Aspartate and alanine transaminases, glucose, and high mobility group box-1 (HMGB-1) protein concentrations showed a significant decreased, and malondialdehyde was increased in the PR group compared with control and PI groups. Interleukin 6 (IL-6) was increased in the PI group compared with control and PR groups. IL-10 and -12 were increased in the PR and PI groups, respectively, when compared with the control group. Glucose decreased in the PR when compared with the control group. Post-conditioning with HFIP led to a decrease in hepatocellular injury and was associated with a downregulation of HMGB-1. The HFIP resulted in a better control of inflammatory response to ischemia-reperfusion even without causing a reduction in oxidative stress.
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Affiliation(s)
- Agustin Vintimilla Moscoso
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Estela Regina Ramos Figueira
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Joel Avancini Rocha‐Filho
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Martin Urner
- Divisao Interdepartamental de Medicina IntensivaUniversidade de TorontoTorontoOntarioCanada
- Instituto de Politicas, Gestao e Avaliaçao de SaudeUniversidade de TorontoTorontoOntarioCanada
| | - Cinthia Lanchotte
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Jose Jukemura
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Jorge Luiz Saraiva Ximenes
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Sergio Carlos Nahas
- Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Luiz Augusto Carneiro D'Albuquerque
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Serviço de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
| | - Flavio Henrique Ferreira Galvao
- Laboratorio de Investigaçao Medica 37, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
- Serviço de Transplante de Figado e Orgaos do Aparelho Digestivo, Departamento de Gastroenterologia, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil
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Nieuwenhuijs-Moeke GJ, Bosch DJ, Leuvenink HG. Molecular Aspects of Volatile Anesthetic-Induced Organ Protection and Its Potential in Kidney Transplantation. Int J Mol Sci 2021; 22:ijms22052727. [PMID: 33800423 PMCID: PMC7962839 DOI: 10.3390/ijms22052727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Ischemia reperfusion injury (IRI) is inevitable in kidney transplantation and negatively impacts graft and patient outcome. Reperfusion takes place in the recipient and most of the injury following ischemia and reperfusion occurs during this reperfusion phase; therefore, the intra-operative period seems an attractive window of opportunity to modulate IRI and improve short- and potentially long-term graft outcome. Commonly used volatile anesthetics such as sevoflurane and isoflurane have been shown to interfere with many of the pathophysiological processes involved in the injurious cascade of IRI. Therefore, volatile anesthetic (VA) agents might be the preferred anesthetics used during the transplantation procedure. This review highlights the molecular and cellular protective points of engagement of VA shown in in vitro studies and in vivo animal experiments, and the potential translation of these results to the clinical setting of kidney transplantation.
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Affiliation(s)
- Gertrude J. Nieuwenhuijs-Moeke
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-631623075
| | - Dirk J. Bosch
- Department of Anesthesiology, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Henri G.D. Leuvenink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
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Emara AM, Alrasheedi KA, Aldubayan MA, Alhowail AH, Elgarabawy RM. Effect of inhaled waste anaesthetic gas on blood and liver parameters among hospital staff. Hum Exp Toxicol 2020; 39:1585-1595. [DOI: 10.1177/0960327120938840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A significant health risk exists within a section of health workers that are exposed to anaesthetic gas and vapours, found in the atmosphere of treatment or operating rooms. These compounds are classified as waste anaesthetic gases (WAG). The present study aimed at identifying alterations in hepatic and haematological parameters occurring as a result of chronic exposure to WAG potentially affecting the health of team members working in hospitals. Therefore, operating room operatives, vulnerable to long-standing WAG exposure, were recruited for this study. Sevoflurane anaesthesia metabolites (inorganic fluoride and hexafluoroisopropanol (HFIP)), haematological indices and liver toxicity markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and osteopontin) were measured. The collected results showed increased plasma inorganic fluoride, HFIP and liver toxicity markers, as well as disturbances in haematological parameters. In conclusion, exposure to halogenated inhalational anaesthetics, in general, and Sevoflurane, in particular, induces alterations in hepatic markers and haematological indices.
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Affiliation(s)
- AM Emara
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - KA Alrasheedi
- Khyber General Hospital, Ministry of Health, Khyber, Saudi Arabia
| | - MA Aldubayan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - AH Alhowail
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - RM Elgarabawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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6
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Luethy A, Kindler CH, Cotten JF. Anesthetic pretreatment confers thermotolerance on Saccharomyces cerevisiae yeast. Biochem Biophys Res Commun 2019; 522:479-484. [PMID: 31780265 DOI: 10.1016/j.bbrc.2019.11.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/20/2022]
Abstract
Saccharomyces cerevisiae yeast, when pretreated with elevated temperatures, undergo adaptive changes that promote survival after an otherwise lethal heat stress. The heat shock response, a cellular stress response variant, mediates these adaptive changes. Ethanol, a low-potency anesthetic, promotes thermotolerance possibly through heat shock response activation. Therefore, we hypothesized other anesthetic compounds, like ethanol, may invoke the heat shock response to promote thermotolerance. To test this hypothesis, we pretreated yeast with a series of non-volatile anesthetic and anesthetic-related compounds and quantified survival following lethal heat shock (52 °C for 5 min). Most compounds invoked thermoprotection and promoted survival with a potency proportional to hydrophobicity: tribromoethanol (5.6 mM, peak survival response), trichloroethanol (17.8 mM), dichloroethanol (100 mM), monochloroethanol (316 mM), trifluoroethanol (177.8 mM), ethanol (1 M), isopropanol (1 M), propofol (316 μM), and carbon tetrabromide (32 μM). Thermoprotection conferred by pretreatment with elevated temperatures was "left shifted" by anesthetic co-treatment from (in °C) 35.3 ± 0.1 to 32.2 ± 0.1 with trifluoroethanol (177.8 mM), to 31.2 ± 0.1 with trichloroethanol (17.8 mM), and to 29.1 ± 0.3 with tribromoethanol (5.6 mM). Yeast in postdiauxic shift growth phase, relative to mid-log, responded with greater heat shock survival; and media supplementation with tryptophan and leucine blocked thermoprotection, perhaps by reversing the amino acid starvation response. Our results suggest S. cerevisase may serve as a model organism for understanding anesthetic toxicity and anesthetic preconditioning, a process by which anesthetics promote tissue survival after hypoxic insult.
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Affiliation(s)
- Anita Luethy
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Department of Anesthesia, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Christoph H Kindler
- Department of Anesthesia, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Switzerland.
| | - Joseph F Cotten
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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7
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Nieuwenhuijs-Moeke GJ, Nieuwenhuijs VB, Seelen MAJ, Berger SP, van den Heuvel MC, Burgerhof JGM, Ottens PJ, Ploeg RJ, Leuvenink HGD, Struys MMRF. Propofol-based anaesthesia versus sevoflurane-based anaesthesia for living donor kidney transplantation: results of the VAPOR-1 randomized controlled trial. Br J Anaesth 2018; 118:720-732. [PMID: 28510740 DOI: 10.1093/bja/aex057] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background Kidney transplantation is associated with harmful processes affecting the viability of the graft. One of these processes is associated with the phenomenon of ischaemia-reperfusion injury. Anaesthetic conditioning is a widely described strategy to attenuate ischaemia-reperfusion injury. We therefore conducted the Volatile Anaesthetic Protection of Renal Transplants-1 trial, a pilot project evaluating the influence of two anaesthetic regimens, propofol- vs sevoflurane-based anaesthesia, on biochemical and clinical outcomes in living donor kidney transplantation. Methods Sixty couples were randomly assigned to the following three groups: PROP (donor and recipient propofol), SEVO (donor and recipient sevoflurane), and PROSE (donor propofol and recipient sevoflurane). The primary outcome was renal injury reflected by urinary biomarkers. The follow-up period was 2 yr. Results Three couples were excluded, leaving 57 couples for analysis. Concentrations of kidney injury molecule-1 (KIM-1), N -acetyl-β- d -glucosaminidase (NAG), and heart-type fatty acid binding protein (H-FABP) in the first urine upon reperfusion showed no differences. On day 2, KIM-1 concentrations were higher in SEVO [952.8 (interquartile range 311.8-1893.0) pg mmol -1 ] compared with PROP [301.2 (202.0-504.7) pg mmol -1 ]. This was the same for NAG: SEVO, 1.835 (1.162-2.457) IU mmol -1 vs PROP, 1.078 (0.819-1.713) IU mmol -1 . Concentrations of H-FABP showed no differences. Measured glomerular filtration rate at 3, 6, and 12 months showed no difference. After 2 yr, there was a difference in the acute rejection rate ( P =0.039). Post hoc testing revealed a difference between PROP (35%) and PROSE (5%; P =0.020). The difference between PROP and SEVO (11%) was not significant ( P =0.110). Conclusions The SEVO group showed higher urinary KIM-1 and NAG concentrations in living donor kidney transplantation on the second day after transplantation. This was not reflected in inferior graft outcome. Clinical trial registration NCT01248871.
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Affiliation(s)
| | - V B Nieuwenhuijs
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Department of Surgery, Isala, Zwolle, The Netherlands
| | | | | | | | - J G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - P J Ottens
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - R J Ploeg
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - H G D Leuvenink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - M M R F Struys
- Department of Anaesthesiology.,Department of Anaesthesia, Ghent University, Ghent, Belgium
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9
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Economic Evaluation of Pharmacologic Pre- and Postconditioning With Sevoflurane Compared With Total Intravenous Anesthesia in Liver Surgery: A Cost Analysis. Anesth Analg 2017; 124:925-933. [PMID: 28067701 PMCID: PMC5305288 DOI: 10.1213/ane.0000000000001814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pharmacologic pre- and postconditioning with sevoflurane compared with total IV anesthesia in patients undergoing liver surgery reduced complication rates as shown in 2 recent randomized controlled trials. However, the potential health economic consequences of these different anesthesia regimens have not yet been assessed. METHODS An expostcost analysis of these 2 trials in 129 patients treated between 2006 and 2010 was performed. We analyzed direct medical costs for in-hospital stay and compared pharmacologic pre- and postconditioning with sevoflurane (intervention) with total IV anesthesia (control) from the perspective of a Swiss university hospital. Year 2015 costs, converted to US dollars, were derived from hospital cost accounting data and compared with a multivariable regression analysis adjusting for relevant covariables. Costs with negative prefix indicate savings and costs with positive prefix represent higher spending in our analysis. RESULTS Treatment-related costs per patient showed a nonsignificant change by -12,697 US dollars (95% confidence interval [CI], 10,956 to -36,352; P = .29) with preconditioning and by -6139 US dollars (95% CI, 6723 to -19,000; P = .35) with postconditioning compared with the control group. Results were robust in our sensitivity analysis. For both procedures (control and intervention) together, major complications led to a significant increase in costs by 86,018 US dollars (95% CI, 13,839-158,198; P = .02) per patient compared with patients with no major complications. CONCLUSIONS In this cost analysis, reduced in-hospital costs by pharmacologic conditioning with sevoflurane in patients undergoing liver surgery are suggested. This possible difference in costs compared with total IV anesthesia is the result of reduced complication rates with pharmacologic conditioning, because major complications have significant cost implications.
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10
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Liu S, Zhang X, Liu F, Paule MG, Callicott R, Newport GD, Ali SF, Patterson TA, Apana SM, Berridge MS, Maisha MP, Hanig JP, Slikker W, Wang C. The Utility of a Nonhuman Primate Model for Assessing Anesthetic-Induced Developmental Neurotoxicity. ACTA ACUST UNITED AC 2017. [DOI: 10.4303/jdar/236011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Abstract
Perioperative acute lung injury (ALI) is a syndrome characterised by hypoxia and chest radiograph changes. It is a serious post-operative complication, associated with considerable mortality and morbidity. In addition to mechanical ventilation, remote organ insult could also trigger systemic responses which induce ALI. Currently, there are limited treatment options available beyond conservative respiratory support. However, increasing understanding of the pathophysiology of ALI and the biochemical pathways involved will aid the development of novel treatments and help to improve patient outcome as well as to reduce cost to the health service. In this review we will discuss the epidemiology of peri-operative ALI; the cellular and molecular mechanisms involved on the pathological process; the clinical considerations in preventing and managing perioperative ALI and the potential future treatment options.
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Affiliation(s)
- Zhaosheng Jin
- Anaesthetics, Pain Medicine and intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK
| | - Ka Chun Suen
- Anaesthetics, Pain Medicine and intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK
| | - Daqing Ma
- Anaesthetics, Pain Medicine and intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea & Westminster Hospital, London SW10 9NH, UK
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12
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Abstract
Abstract
Background
One-lung ventilation during thoracic surgery is associated with hypoxia–reoxygenation injury in the deflated and subsequently reventilated lung. Numerous studies have reported volatile anesthesia–induced attenuation of inflammatory responses in such scenarios. If the effect also extends to clinical outcome is yet undetermined. We hypothesized that volatile anesthesia is superior to intravenous anesthesia regarding postoperative complications.
Methods
Five centers in Switzerland participated in the randomized controlled trial. Patients scheduled for lung surgery with one-lung ventilation were randomly assigned to one of two parallel arms to receive either propofol or desflurane as general anesthetic. Patients and surgeons were blinded to group allocation. Time to occurrence of the first major complication according to the Clavien-Dindo score was defined as primary (during hospitalization) or secondary (6-month follow-up) endpoint. Cox regression models were used with adjustment for prestratification variables and age.
Results
Of 767 screened patients, 460 were randomized and analyzed (n = 230 for each arm). Demographics, disease and intraoperative characteristics were comparable in both groups. Incidence of major complications during hospitalization was 16.5% in the propofol and 13.0% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.75; 95% CI, 0.46 to 1.22; P = 0.24). Incidence of major complications within 6 months from surgery was 40.4% in the propofol and 39.6% in the desflurane groups (hazard ratio for desflurane vs. propofol, 0.95; 95% CI, 0.71 to 1.28; P = 0.71).
Conclusions
This is the first multicenter randomized controlled trial addressing the effect of volatile versus intravenous anesthetics on major complications after lung surgery. No difference between the two anesthesia regimens was evident.
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Inhaled Anesthetics Exert Different Protective Properties in a Mouse Model of Ventilator-Induced Lung Injury. Anesth Analg 2016; 123:143-51. [DOI: 10.1213/ane.0000000000001296] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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14
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Pevzner LM, Polukeev VA. Synthesis and some transformations of diethyl (5-trifluoromethylfur-2-yl)methanephosphonate. RUSS J GEN CHEM+ 2015. [DOI: 10.1134/s1070363215090169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Urner M, Schläpfer M, Herrmann IK, Hasler M, Schimmer RR, Booy C, Roth Z'graggen B, Rehrauer H, Aigner F, Minshall RD, Stark WJ, Beck-Schimmer B. Insight into the beneficial immunomodulatory mechanism of the sevoflurane metabolite hexafluoro-2-propanol in a rat model of endotoxaemia. Clin Exp Immunol 2015; 181:468-79. [PMID: 25925908 DOI: 10.1111/cei.12648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 12/13/2022] Open
Abstract
Volatile anaesthetics such as sevoflurane attenuate inflammatory processes, thereby impacting patient outcome significantly. Their inhalative administration is, however, strictly limited to controlled environments such as operating theatres, and thus an intravenously injectable immunomodulatory drug would offer distinct advantages. As protective effects of volatile anaesthetics have been associated with the presence of trifluorinated carbon groups in their basic structure, in this study we investigated the water-soluble sevoflurane metabolite hexafluoro-2-propanol (HFIP) as a potential immunomodulatory drug in a rat model of endotoxic shock. Male Wistar rats were subjected to intravenous lipopolysaccharide (LPS) and thereafter were treated with HFIP. Plasma and tissue inflammatory mediators, neutrophil invasion, tissue damage and haemodynamic stability were the dedicated end-points. In an endotoxin-induced endothelial cell injury model, underlying mechanisms were elucidated using gene expression and gene reporter analyses. HFIP reduced the systemic inflammatory response significantly and decreased endotoxin-induced tissue damage. Additionally, the LPS-provoked drop in blood pressure of animals was resolved by HFIP treatment. Pathway analysis revealed that the observed attenuation of the inflammatory process was associated with reduced nuclear factor kappa B (NF-κΒ) activation and suppression of its dependent transcripts. Taken together, intravenous administration of HFIP exerts promising immunomodulatory effects in endotoxaemic rats. The possibility of intravenous administration would overcome limitations of volatile anaesthetics, and thus HFIP might therefore represent an interesting future drug candidate for states of severe inflammation.
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Affiliation(s)
- M Urner
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - M Schläpfer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - I K Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - M Hasler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - R R Schimmer
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - C Booy
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - B Roth Z'graggen
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Functional Genomics Center Zurich, University of Zurich, Zurich, Switzerland
| | - H Rehrauer
- Functional Genomics Center Zurich, University of Zurich, Zurich, Switzerland
| | - F Aigner
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - R D Minshall
- Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA
| | - W J Stark
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, Zurich, Switzerland
| | - B Beck-Schimmer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.,Department of Anesthesiology, University of Illinois Chicago, Chicago, IL, USA
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Minguet G, Franck T, Joris J, Ceusters J, Mouithys-Mickalad A, Serteyn D, Sandersen C. Effects of isoflurane and sevoflurane on the neutrophil myeloperoxidase system of horses. Vet Immunol Immunopathol 2015; 165:93-7. [PMID: 25796094 DOI: 10.1016/j.vetimm.2015.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/10/2015] [Accepted: 02/26/2015] [Indexed: 02/01/2023]
Abstract
Volatile anaesthestics have shown to modulate the oxidative response of polymorphonuclear neutrophils (PMNs). We investigated the effects of isoflurane and sevoflurane on the degranulation of total and active myeloperoxidase (MPO) from horse PMNs and their direct interaction with MPO activity. Whole blood from horse was incubated in 1 and 2 minimal alveolar concentrations (MAC) of isoflurane or sevoflurane for 1h and PMNs were stimulated with cytochalasin B (CB) plus N-formyl-méthionyl-leucyl-phenylalanine (fMLP). After stimulation, the plasma was collected to measure total and active MPO by enzyme-linked immunosorbent assay (ELISA) and specific immunological extraction followed by enzymatic detection (SIEFED) respectively. The effects of 1 and 2 MAC of isoflurane and sevoflurane on the peroxidase and chlorination activity of pure MPO were assessed by fluorescence using Amplex red and 3'-(p-aminophenyl) fluorescein (APF) respectively and in parallel with a SIEFED assay to estimate the potential interaction of the anaesthetics with the enzyme. Although isoflurane and sevoflurane had inconsistent effects on total MPO release, both volatile agents reduced active MPO release and showed a direct inhibition on the peroxidase and the chlorination activity of the enzyme. A persistent interaction between MPO and anaesthetics was evidenced with isoflurane but not with sevoflurane.
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Affiliation(s)
- Grégory Minguet
- Department of Anaesthesia and Intensive Care Medicine, CHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium.
| | - Thierry Franck
- Center for Oxygen Research and Development, Institute of Chemistry B6a, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Jean Joris
- Department of Anaesthesia and Intensive Care Medicine, CHU de Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Justine Ceusters
- Center for Oxygen Research and Development, Institute of Chemistry B6a, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Ange Mouithys-Mickalad
- Center for Oxygen Research and Development, Institute of Chemistry B6a, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Didier Serteyn
- Center for Oxygen Research and Development, Institute of Chemistry B6a, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium; Department of Clinical Sciences, Anaesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Charlotte Sandersen
- Department of Clinical Sciences, Anaesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liège, Domaine Universitaire du Sart-Tilman, 4000 Liège, Belgium
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Shen QY, Fang L, Wu HM, He F, Ding PS, Liu RY. Repeated inhalation of sevoflurane inhibits airway inflammation in an OVA-induced mouse model of allergic airway inflammation. Respirology 2014; 20:258-63. [PMID: 25399488 DOI: 10.1111/resp.12439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/31/2014] [Accepted: 09/15/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Repeated inhalation of sevoflurane (SVF) can benefit asthmatic patients by bronchodilation. However, the impact of repeated inhalation of SVF on allergic airway inflammation has not been clarified. This study was aimed at investigating the effects of repeated inhalation of SVF on airway inflammation in mice. METHODS Female C57BL/6 mice were sensitized with ovalbumin (OVA) and treated by inhalation with SVF or vehicle daily for seven consecutive days, immediately followed by OVA challenge. Airway inflammation was evaluated by counting the numbers of different types of inflammatory infiltrates in bronchoalveolar lavage fluid (BALF), histology, cytokine measurements and mucus production in individual mice. RESULTS In comparison with the OVA group, repeated inhalation of SVF significantly reduced the numbers of total cells, eosinophils, lymphocytes, macrophages and neutrophils (P < 0.05 to P < 0.01), and the levels of BALF tumour necrosis factor-α and lung high-mobility group box 1 (P < 0.01), accompanied by elevated levels of BALF interleukin-10 in allergic mice (P < 0.05). Repeat inhalation of SVF decreased the levels of serum OVA-specific immunoglobulin E (IgE) and mitigated allergic airway epithelial goblet cell hyperplasia and mucus hypersecretion in allergic mice (P < 0.01). CONCLUSIONS Repeated inhalation of SVF inhibits allergic airway inflammation by reducing inflammatory infiltrates, improving the imbalance of cytokine responses and mitigating allergen-specific IgE responses and goblet cell hyperplasia in mice.
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Affiliation(s)
- Qi-Ying Shen
- Department of Pulmonary, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China; Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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18
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Anderson SL, Duke-Novakovski T, Singh B. The immune response to anesthesia: part 1. Vet Anaesth Analg 2014; 41:113-26. [PMID: 24588928 DOI: 10.1111/vaa.12125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/07/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To review the immune response to anesthesia including mechanical ventilation, inhaled anesthetic gases, and injectable anesthetics and sedatives. STUDY DESIGN Review. METHODS AND DATABASES Multiple literature searches were performed using PubMed and Google Scholar from spring 2012 through fall 2013. Relevant anesthetic and immune terms were used to search databases without year published or species constraints. The online database for Veterinary Anaesthesia and Analgesia and the Journal of Veterinary Emergency and Critical Care were searched by issue starting in 2000 for relevant articles. CONCLUSION Recent research data indicate that commonly used volatile anesthetic agents, such as isoflurane and sevoflurane, may have a protective effect on vital organs. With the lung as the target organ, protection using an appropriate anesthetic protocol may be possible during direct pulmonary insults, including mechanical ventilation, and during systemic disease processes, such as endotoxemia, generalized sepsis, and ischemia-reperfusion injury.
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Affiliation(s)
- Stacy L Anderson
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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19
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Khanna AK, Perez ER, Laudanski K, Moraska A, III KCC. Perioperative care and cancer recurrence: Is there a connection? World J Anesthesiol 2014; 3:31-45. [DOI: 10.5313/wja.v3.i1.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/13/2013] [Accepted: 02/18/2014] [Indexed: 02/06/2023] Open
Abstract
Cancer is the second most common cause of death in the United States. Metastatic disease is a more important cause of cancer-related death relative to primary tumor progression. Surgical excision is the primary treatment for most malignant tumors. However, surgery itself can inhibit important host defenses and promote the development of metastases. An altered balance between the metastatic potential of the tumor and the anti-metastatic host defenses, including cell-mediated immunity and natural killer cell function, is a plausible mechanism of increased cancer metastasis. This article reviews the increasingly recognized concept of anesthetic technique along with perioperative factors and their potential to affect long-term outcome after cancer surgery. The potential effect of intravenous anesthetics, volatile agents, local anesthetic drugs, opiates, and non-steroidal anti-inflammatory drugs are reviewed along with recent literature and ongoing clinical trials in this area. Regional anesthesia is increasingly emerging as a safer option with less cancer recurrence potential as compared to general anesthesia. Blood transfusion, pain, stress, use of beta-blockers, and hypothermia are other potentially important perioperative factors to consider.
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20
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Fukazawa K, Lee HT. Volatile anesthetics and AKI: risks, mechanisms, and a potential therapeutic window. J Am Soc Nephrol 2014; 25:884-92. [PMID: 24511126 DOI: 10.1681/asn.2013111215] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AKI is a major clinical problem with extremely high mortality and morbidity. Kidney hypoxia or ischemia-reperfusion injury inevitably occurs during surgery involving renal or aortic vascular occlusion and is one of the leading causes of perioperative AKI. Despite the growing incidence and tremendous clinical and financial burden of AKI, there is currently no effective therapy for this condition. The pathophysiology of AKI is orchestrated by renal tubular and endothelial cell necrosis and apoptosis, leukocyte infiltration, and the production and release of proinflammatory cytokines and reactive oxygen species. Effective management strategies require multimodal inhibition of these injury processes. Despite the past theoretical concerns about the nephrotoxic effects of several clinically utilized volatile anesthetics, recent studies suggest that modern halogenated volatile anesthetics induce potent anti-inflammatory, antinecrotic, and antiapoptotic effects that protect against ischemic AKI. Therefore, the renal protective properties of volatile anesthetics may provide clinically useful therapeutic intervention to treat and/or prevent perioperative AKI. In this review, we outline the history of volatile anesthetics and their effect on kidney function, briefly review the studies on volatile anesthetic-induced renal protection, and summarize the basic cellular mechanisms of volatile anesthetic-mediated protection against ischemic AKI.
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Affiliation(s)
- Kyota Fukazawa
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York
| | - H Thomas Lee
- Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York
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21
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Casale T, Caciari T, Rosati MV, Gioffrè PA, Schifano MP, Capozzella A, Pimpinella B, Tomei G, Tomei F. Anesthetic gases and occupationally exposed workers. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2014; 37:267-274. [PMID: 24374387 DOI: 10.1016/j.etap.2013.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 06/03/2023]
Abstract
The aim of this study is to estimate whether the occupational exposure to low dose anesthetic gases could cause alterations of blood parameters in health care workers. 119 exposed subjects and 184 not exposed controls were included in the study. Each worker underwent the complete blood count test (CBC), proteinaemia, leukocyte count, serum lipids, liver and kidney blood markers. The liver blood markers show statistically significant differences in health care workers compared with controls (p<0.05), a statistically significant decrease in neutrophils and an increase of lymphocytes in health care workers compared with controls (p<0.05). The prevalence of values outside the range for GPT, GGT, total bilirubin, lymphocytes and neutrophils was statistically significant in health care workers compared with controls (p<0.05). The results suggest that occupational exposure to low dose anesthetic gases could influence some haematochemical hepatic and hematopoietic parameters in exposed health care workers.
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Affiliation(s)
- Teodorico Casale
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy.
| | - Tiziana Caciari
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Maria Valeria Rosati
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Pier Agostino Gioffrè
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Maria Pia Schifano
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Assunta Capozzella
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Benedetta Pimpinella
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Gianfranco Tomei
- Department of Psychiatric and Psychological Science, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesco Tomei
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
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Herrmann IK, Castellon M, Schwartz DE, Hasler M, Urner M, Hu G, Minshall RD, Beck-Schimmer B. Intravenous application of a primary sevoflurane metabolite improves outcome in murine septic peritonitis: first results. PLoS One 2013; 8:e72057. [PMID: 23977207 PMCID: PMC3747167 DOI: 10.1371/journal.pone.0072057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/06/2013] [Indexed: 02/04/2023] Open
Abstract
Volatile anesthetics are known to have immunomodulatory effects in conditions of organ injury. A recent study in an experimental sepsis model has shown remarkably improved survival when mice were exposed to volatile anesthetics. In the present study, we show that hexafluoroisopropanol – a water-soluble primary sevoflurane metabolite – has beneficial effects on the overall survival in a murine model of cecal ligation and puncture. Seven-day survival as well as tissue damage markers including transaminases and high mobility group box protein-1 were assessed as measures of end organ damage. In animals undergoing cecal ligation and puncture procedure hexafluoroisopropanol conditioning - but not late postconditioning 24 hours after sepsis induction - significantly increased survival rate (17% vs. 77%, p = 0.037) and attenuated secretion of organ damage markers. This study shows survival benefits by administration of the metabolite of a volatile anesthetic. If successfully translated, hexafluoroisopropanol might offer interesting therapeutic opportunities in the future treatment of abdominal sepsis.
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Affiliation(s)
- Inge K. Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Maricela Castellon
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States of America
- Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - David E. Schwartz
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States of America
| | - Melanie Hasler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Martin Urner
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Guochang Hu
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States of America
- Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Richard D. Minshall
- Department of Anesthesiology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, United States of America
- Department of Pharmacology, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Beatrice Beck-Schimmer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Herrmann IK, Urner M, Graf S, Schumacher CM, Roth‐Z'graggen B, Hasler M, Stark WJ, Beck‐Schimmer B. Endotoxin removal by magnetic separation-based blood purification. Adv Healthc Mater 2013; 2:829-35. [PMID: 23225582 DOI: 10.1002/adhm.201200358] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Indexed: 12/20/2022]
Abstract
This work describes a magnetic separation-based approach using polymyxin B-functionalized metal alloy nanomagnets for the rapid elimination of endotoxins from human blood in vitro and functional assays to evaluate the biological relevance of the blood purification process. Playing a central role in gram-negative sepsis, bacteria-derived endotoxins are attractive therapeutic targets. However, both direct endotoxin detection in and removal from protein-rich fluids remains challenging. We present the synthesis and functionalization of ultra-magnetic cobalt/iron alloy nanoparticles and a magnetic separation-based approach using polymyxin B-functionalized nanomagnets to remove endotoxin from human blood in vitro. Conventional chromogenic Limulus Amebocyte Lysate assays confirm decreased endotoxin activity in purified compared to untreated samples. Functional assays assessing key steps in host defense against bacteria show an attenuated inflammatory mediator expression from human primary endothelial cells in response to purified blood samples compared to untreated blood and less chemotactic activity. Exposing Escherichia coli-positive blood samples to polymyxin B-functionalized nanomagnets even impairs the ability of gram-negative bacteria to form colony forming units, thus making magnetic separation based blood purification a promising new approach for future sepsis treatment.
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Affiliation(s)
- Inge K. Herrmann
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
| | - Martin Urner
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
| | - Samuel Graf
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
| | - Christoph M. Schumacher
- ETH Zurich, Institute of Chemical and Bioengineering, Wolfgang‐Pauli‐Strasse 10, 8093 Zurich, Switzerland
| | - Birgit Roth‐Z'graggen
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
| | - Melanie Hasler
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
| | - Wendelin J. Stark
- ETH Zurich, Institute of Chemical and Bioengineering, Wolfgang‐Pauli‐Strasse 10, 8093 Zurich, Switzerland
| | - Beatrice Beck‐Schimmer
- University Hospital Zurich, Institute of Anesthesiology, Raemistrasse 100, 8091 Zurich, Switzerland, University of Zurich, Institute of Physiology and Zurich Center for Integrative Human Physiology, Winterthurerstrasse 190, 8057 Zurich, Switzerland, Tel: +41 44 255 56 32; Fax: +41 44 255 44 09
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Rodríguez-González R, Baluja A, Veiras Del Río S, Rodríguez A, Rodríguez J, Taboada M, Brea D, Álvarez J. Effects of sevoflurane postconditioning on cell death, inflammation and TLR expression in human endothelial cells exposed to LPS. J Transl Med 2013; 11:87. [PMID: 23552565 PMCID: PMC3636049 DOI: 10.1186/1479-5876-11-87] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/13/2013] [Indexed: 01/16/2023] Open
Abstract
Background Sevoflurane is an anesthetic agent which also participates in protective mechanisms in sepsis, likely due to anti-inflammatory properties. A key tissue in sepsis is the endothelium, which expresses TLR2 and TLR4 receptors, known regulators of inflammatory mechanisms and potential therapeutic targets for this pathology. In this context, we explored the effect of sevoflurane postconditioning in an in vitro sepsis model. Methods Primary cultures of human umbilical vein endothelial cells were used for two different experiments. In the first set, cultures were placed in an airtight incubation chamber and exposed to different concentrations of sevoflurane (0,1,3 or 7% vol,) for 1 hour. In the second set, lipopolysaccharide from Escherichia coli 0111:B4 (1 μg/mL) was added to culture medium for 3 hours and cells were subsequently exposed to sevoflurane (0,1,3 or 7% vol,) for 1 hour as explained before. In both cases, cell viability was measured by MTT and Trypan blue assays, TLR2 and TLR4 expression were analyzed by flow cytometry, and TNFα and IL-6 levels were quantified in cell culture media by an immunoassay immediately after exposure, at 6 and 24 hours. Results Exposure to 3% sevoflurane decreased TLR2 at 24 hours and TLR4 at 6 and 24 hours (both p<0.05), whereas exposure to 7% decreased TLR4 expression at 6 hours (p<0.05). Both 3 and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). In LPS-stimulated cultures, exposure to 3% sevoflurane was cytoprotective at 6 and 24 hours (p<0.05) compared with control, and decreased TLR2 and TLR4 expression at 24 hours (p<0.05); whereas 7% decreased TLR4 expression at 24 hours (p<0.05). Both 3% and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). Conclusions Postconditioning with the halogenated anesthetic agent sevoflurane after LPS stimulation shows a cytoprotective effect in an in vitro model, decreasing cell death and reducing TLR2 and TLR4 expression as well as levels of the inflammatory mediators TNF-α and IL-6 in human endothelial cells.
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Affiliation(s)
- Raquel Rodríguez-González
- Critical Patient Translational Research Group, Department of Anesthesiology, Intensive Care and Pain Management, Hospital Clínico Universitario, IDIS, University of Santiago de Compostela, Santiago de Compostela, Spain
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25
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Year in review in Intensive Care Medicine 2012: I. Neurology and neurointensive care, epidemiology and nephrology, biomarkers and inflammation, nutrition, experimentals. Intensive Care Med 2012; 39:232-46. [PMID: 23248038 PMCID: PMC3569582 DOI: 10.1007/s00134-012-2774-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 01/06/2023]
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Schläpfer M, Leutert AC, Voigtsberger S, Lachmann RA, Booy C, Beck-Schimmer B. Sevoflurane reduces severity of acute lung injury possibly by impairing formation of alveolar oedema. Clin Exp Immunol 2012; 168:125-34. [PMID: 22385247 PMCID: PMC3390503 DOI: 10.1111/j.1365-2249.2012.04562.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2011] [Indexed: 11/27/2022] Open
Abstract
Pulmonary oedema is a hallmark of acute lung injury (ALI), consisting of various degrees of water and proteins. Physiologically, sodium enters through apical sodium channels (ENaC) and is extruded basolaterally by a sodium-potassium-adenosine-triphosphatase pump (Na(+) /K(+) -ATPase). Water follows to maintain iso-osmolar conditions and to keep alveoli dry. We postulated that the volatile anaesthetic sevoflurane would impact oedema resolution positively in an in-vitro and in-vivo model of ALI. Alveolar epithelial type II cells (AECII) and mixed alveolar epithelial cells (mAEC) were stimulated with 20 µg/ml lipopolysaccharide (LPS) and co-exposed to sevoflurane for 8 h. In-vitro active sodium transport via ENaC and Na(+) /K(+) -ATPase was determined, assessing (22) sodium and (86) rubidium influx, respectively. Intratracheally applied LPS (150 µg) was used for the ALI in rats under sevoflurane or propofol anaesthesia (8 h). Oxygenation index (PaO(2) /FiO(2) ) was calculated and lung oedema assessed determining lung wet/dry ratio. In AECII LPS decreased activity of ENaC and Na(+) /K(+) -ATPase by 17·4% ± 13·3% standard deviation and 16·2% ± 13·1%, respectively. These effects were reversible in the presence of sevoflurane. Significant better oxygenation was observed with an increase of PaO(2) /FiO(2) from 189 ± 142 mmHg to 454 ± 25 mmHg after 8 h in the sevoflurane/LPS compared to the propofol/LPS group. The wet/dry ratio in sevoflurane/LPS was reduced by 21·6% ± 2·3% in comparison to propofol/LPS-treated animals. Sevoflurane has a stimulating effect on ENaC and Na(+) /K(+) -ATPase in vitro in LPS-injured AECII. In-vivo experiments, however, give strong evidence that sevoflurane does not affect water reabsorption and oedema resolution, but possibly oedema formation.
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Affiliation(s)
- M Schläpfer
- Institute of Anesthesiology, University Hospital Zurich Institute of Physiology and Center for Integrative Human Physiology, University of Zurich, Winterthurerstrasse 190, Zurich, Switzerland
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27
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Urner M, Herrmann IK, Buddeberg F, Schuppli C, Roth Z'graggen B, Hasler M, Schanz U, Mehr M, Spahn DR, Beck Schimmer B. Effects of blood products on inflammatory response in endothelial cells in vitro. PLoS One 2012; 7:e33403. [PMID: 22438924 PMCID: PMC3306413 DOI: 10.1371/journal.pone.0033403] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 02/10/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Transfusing blood products may induce inflammatory reactions within the vascular compartment potentially leading to a systemic inflammatory response. Experiments were designed to assess the inflammatory potential of different blood products in an endothelial cell-based in vitro model and to compare baseline levels of potentially activating substances in transfusion products. METHODS The inflammatory response from pre-activated (endotoxin-stimulated) and non-activated endothelial cells as well as neutrophil endothelial transmigration in response to packed red blood cells (PRBC), platelet concentrates (PC) and fresh frozen plasma (FFP) was determined. Baseline inflammatory mediator and lipid concentrations in blood products were evaluated. RESULTS Following incubation with all blood products, an increased inflammatory mediator release from endothelial cells was observed. Platelet concentrates, and to a lesser extent also FFP, caused the most pronounced response, which was accentuated in already pre-stimulated endothelial cells. Inflammatory response of endothelial cells as well as blood product-induced migration of neutrophils through the endothelium was in good agreement with the lipid content of the according blood product. CONCLUSION Within the group of different blood transfusion products both PC and FFP have a high inflammatory potential with regard to activation of endothelial cells. Inflammation upon blood product exposure is strongly accentuated when endothelial cells are pre-injured. High lipid contents in the respective blood products goes along with an accentuated inflammatory reaction from endothelial cells.
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Affiliation(s)
- Martin Urner
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Inge K. Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Felix Buddeberg
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Caroline Schuppli
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Birgit Roth Z'graggen
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Melanie Hasler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Urs Schanz
- Clinic of Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Manuela Mehr
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Urner M, Herrmann IK, Hasler M, Booy C, Beck-Schimmer B. Effects of hexafluoro-2-propanol on inflammatory and hemodynamic responses in a rat model of endotoxic shock. Crit Care 2012. [PMCID: PMC3363437 DOI: 10.1186/cc10626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Sugasawa Y, Yamaguchi K, Kumakura S, Murakami T, Suzuki K, Nagaoka I, Inada E. Effects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection. J Anesth 2011; 26:62-9. [DOI: 10.1007/s00540-011-1244-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022]
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