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Jia D, Wang F, Bai Z, Chen X. BDNF-TrkB/proBDNF-p75 NTR pathway regulation by lipid emulsion rescues bupivacaine-induced central neurotoxicity in rats. Sci Rep 2023; 13:18364. [PMID: 37884604 PMCID: PMC10603093 DOI: 10.1038/s41598-023-45572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023] Open
Abstract
Bupivacaine (BPV) can cause severe central nervous system toxicity when absorbed into the blood circulation system. Rapid intravenous administration of lipid emulsion (LE) could be used to treat local anaesthetic toxicity. This study aimed to investigate the mechanism by which the BDNF-TrkB/proBDNF-p75NTR pathway regulation by LE rescues BPV induced neurotoxicity in hippocampal neurons in rats. Seven- to nine-day-old primary cultured hippocampal neurons were randomly divided into 6 groups: the blank control group (Ctrl), the bupivacaine group (BPV), the lipid emulsion group (LE), the bupivacaine + lipid emulsion group (BPV + LE), the bupivacaine + lipid emulsion + tyrosine kinase receptor B (TrkB) inhibitor group (BPV + LE + K252a), the bupivacaine + lipid emulsion + p75 neurotrophic factor receptor (p75NTR) inhibitor group (BPV + LE + TAT-Pep5). All hippocampal neurons were incubated for 24 h, and their growth state was observed by light microscopy. The relative TrkB and p75NTR mRNA levels were detected by real-time PCR. The protein expression levels of brain-derived neurotrophic factor (BDNF), proBDNF, TrkB, p75NTR and cleaved caspase-3 were detected by western blotting. The results showed that primary hippocampal neuron activity was reduced by BPV. As administration of LE elevated hippocampal neuronal activity, morphology was also somewhat improved. The protein expression and mRNA levels of TrkB and p75NTR were decreased when BPV induced hippocampal neuronal toxicity, while the expression of BDNF was increased. At the same time, BPV increased the original generation of cleaved caspase-3 protein content by hippocampal neurons, while the content of cleaved caspase-3 protein in hippocampal neurons cotreated with LE and BPV was decreased. Thus, this study has revealed LE may reduce apoptosis and promote survival of hippocampal neurons by regulating the BDNF-TrkB pathway and the proBDNF-p75NTR pathway to rescue BPV induced central neurotoxicity in rats.
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Affiliation(s)
- Danting Jia
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Fang Wang
- Department of Anaesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia, China
| | - Zhixia Bai
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Xuexin Chen
- Department of Anesthesiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
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Ok SH, Kang D, Lee SH, Kim HJ, Ahn SH, Sohn JT. Lipid emulsions attenuate the inhibition of carnitine acylcarnitine translocase induced by toxic doses of local anesthetics in rat cardiomyoblasts. Hum Exp Toxicol 2022; 41:9603271211065978. [PMID: 35135371 DOI: 10.1177/09603271211065978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of this study was to examine the effects of lipid emulsions on carnitine palmitoyltransferase I (CPT-I), carnitine acylcarnitine translocase (CACT), carnitine palmitoyltransferase II (CPT-II), and the mitochondrial dysfunctions induced by toxic doses of local anesthetics in H9c2 rat cardiomyoblasts. The effects of local anesthetics and lipid emulsions on the activities of CPT-I, CACT, and CPT-II, and concentrations of local anesthetics were examined. The effects of lipid emulsions, N-acetyl-L-cysteine (NAC), and mitotempo on the bupivacaine-induced changes in cell viability, reactive oxygen species (ROS) levels, mitochondrial membrane potential (MMP), and intracellular calcium levels were examined. CACT, without significantly altering CPT-I and CPT-II, was inhibited by toxic concentration of local anesthetics. The levobupivacaine- and bupivacaine-induced inhibition of CACT was attenuated by all concentrations of lipid emulsion, whereas the ropivacaine-induced inhibition of CACT was attenuated by medium and high concentrations of lipid emulsion. The concentration of levobupivacaine was slightly attenuated by lipid emulsion. The bupivacaine-induced increase of ROS and calcium and the bupivacaine-induced decrease of MMP were attenuated by ROS scavengers NAC and mitotempo, and the lipid emulsion. Collectively, these results suggested that the lipid emulsion attenuated the levobupivacaine-induced inhibition of CACT, probably through the lipid emulsion-mediated sequestration of levobupivacaine.
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Affiliation(s)
- Seong-Ho Ok
- Department of Anesthesiology and Pain Medicine, 26720Gyeongsang National University, Changwon-si, Republic of Korea.,Department of Anesthesiology and Pain Medicine, 65442Gyeongsang National University College of Medicine, Jinju-si, Republic of Korea.,Institute of Health Sciences, 26720Gyeongsang National University, Jinju-si, Republic of Korea
| | - Dawon Kang
- Department of Physiology, 65442Gyeongsang National University College of Medicine, Jinju-si, Republic of Korea
| | - Soo Hee Lee
- Department of Anesthesiology and Pain Medicine, 26720Gyeongsang National University, Changwon-si, Republic of Korea.,Department of Anesthesiology and Pain Medicine, 65442Gyeongsang National University College of Medicine, Jinju-si, Republic of Korea
| | - Hyun-Jin Kim
- Division of Applied Life Sciences (BK21 four), 26720Gyeongsang National University, Gyeongsang, Republic of Korea.,Department of Food Science & Technology, Institute of Agriculture and Life Science, 26720Gyeongsang National University, Gyeongsang, Republic of Korea
| | - Seung Hyun Ahn
- Department of Anesthesiology and Pain Medicine, 90162Gyeongsang National University Hospital, Jinju-si, Republic of Korea
| | - Ju-Tae Sohn
- Institute of Health Sciences, 26720Gyeongsang National University, Jinju-si, Republic of Korea.,Department of Anesthesiology and Pain Medicine, Gyeongsang National University College of Medicine, 90162Gyeongsang National University Hospital, Jinju-si, Republic of Korea
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Peuchot H, Khakha R, Riera V, Ollivier M, Argenson JN. Intraoperative virtual reality distraction in TKA under spinal anesthesia: a preliminary study. Arch Orthop Trauma Surg 2021; 141:2323-2328. [PMID: 34292380 DOI: 10.1007/s00402-021-04065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The effect of patient anxiety during the perioperative period has been shown to be of great importance in its influence on post-operative recovery. Over the last 10 years, virtual reality (VR) has been developed in anesthesia for patient's distraction by immersion. The aim of this study was to evaluate post-operative patient anxiety the day after TKA surgery under spinal anesthesia (SA) with or without VR distraction. MATERIALS AND METHODS A single-center, prospective cohort study was performed looking at patients undergoing TKA surgery under SA with a VR headset (group 1) compared with those undergoing the same procedure with standard protocol (group 2). Data using a validated scoring system looking at patient anxiety (STAI Y-1) were collected. Secondary endpoints were need for sedation during surgery, intraoperative complications (hypotension and oxygen need), postoperative pain and comfort scores (VAS) and patient satisfaction. RESULTS Ten patients (group 1) received the VR headset during surgery and 10 (group 2) received the standard protocol established in our center. Average age was 73 years old. No difference was found in post-operative patient anxiety regarding to STAI Y-1 score (95% CI - 7 to 10, p = 0.71. There was a decrease of sedation and intra-operative adverse event as hypotension and oxygen requirement in group 1 (p < 0.0001, p = 0.015, p = 0.0054), and a significant increase in comfort score (p = 0.002). No difference in patient satisfaction was found. CONCLUSION Using VR for immersive distraction seemed to lead to no difference in patient anxiety in TKA under SA. Intra-operative adverse events were decreased, and post-operative comfort was increased. Patient satisfaction was not modified. This preliminary study is encouraging and gives us arguments to involve larger number of patients while exploring the various possibilities offered by VR.
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Affiliation(s)
- H Peuchot
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009, Marseille, France
| | - R Khakha
- Guys and St Thomas' Hospitals, London, England
| | - V Riera
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009, Marseille, France.,Department of Anesthesiology, Aix-Marseille University, Marseille, France
| | - M Ollivier
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009, Marseille, France
| | - J-N Argenson
- Institute for Locomotion, Department of Orthopedic Surgery, Aix-Marseille University, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009, Marseille, France.
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Liu Y, Zhang J, Yu P, Niu J, Yu S. Mechanisms and Efficacy of Intravenous Lipid Emulsion Treatment for Systemic Toxicity From Local Anesthetics. Front Med (Lausanne) 2021; 8:756866. [PMID: 34820396 PMCID: PMC8606423 DOI: 10.3389/fmed.2021.756866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Local anesthetics are widely used clinically for perioperative analgesia to achieve comfort in medical treatment. However, when the concentration of local anesthetics in the blood exceeds the tolerance of the body, local anesthetic systemic toxicity (LAST) will occur. With the development and popularization of positioning technology under direct ultrasound, the risks and cases of LAST associated with direct entry of the anesthetic into the blood vessel have been reduced. Clinical occurrence of LAST usually presents as a series of severe toxic reactions such as myocardial depression, which is life-threatening. In addition to basic life support (airway management, advanced cardiac life support, etc.), intravenous lipid emulsion (ILE) has been introduced as a treatment option in recent years and has gradually become the first-line treatment for LAST. This review introduces the mechanisms of LAST and identifies the clinical symptoms displayed by the central nervous system and cardiovascular system. The paper features the multimodal mechanism of LAST reversal by ILE, describes research progress in the field, and identifies other anesthetics involved in the resuscitation process of LAST. Finally, the review presents key issues in lipid therapy. Although ILE has achieved notable success in the treatment of LAST, adverse reactions and contraindications also exist; therefore, ILE requires a high degree of attention during use. More in-depth research on the treatment mechanism of ILE, the resuscitation dosage and method of ILE, and the combined use with other resuscitation measures is needed to improve the efficacy and safety of clinical resuscitation after LAST in the future.
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Affiliation(s)
- Yang Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiangfeng Niu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
| | - Shuchun Yu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Key Laboratory of Anesthesiology of Jiangxi Province, Nanchang, China
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Wang C, Liang X, Yu Y, Li Y, Wen X, Liu M. Electroacupuncture pretreatment alleviates myocardial injury through regulating mitochondrial function. Eur J Med Res 2020; 25:29. [PMID: 32738910 PMCID: PMC7395969 DOI: 10.1186/s40001-020-00431-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Electroacupuncture is well known for its advantageous neuroanalgesic and therapeutic effects on myocardial ischemia–reperfusion injury. The purpose of the present research was to verify whether electroacupuncture can alleviate bupivacaine-induced myocardial injury. Methods Specific pathogen-free Wistar rats were used to establish the bupivacaine-induced myocardial injury model. Western blot, PCR, transmission electron microscope and enzyme-linked immunosorbent (ELISA) methods were used to evaluate bupivacaine-induced structure injury and dysfunction of the mitochondria as well as the alleviating effects of lipid emulsion, acupoint injection, and electroacupuncture pre-treatment of the oxidase stress response. Results Bupivacaine caused structural damage, degradation, and swelling of mitochondria. Furthermore, it reduced adenosine triphosphate (ATP) synthesis and impaired energy metabolism in the mitochondria. Structural and functional impairment of the mitochondria was alleviated via lipid emulsion injection, acupoint injection, and electroacupuncture pre-treatment. Electroacupuncture pre-treatment of PC6 yielded a greater alleviating effect than others approaches. Following electroacupuncture pre-treatment of PC6 point, the number of mitochondria increased; apoptosis was reduced, enzymatic activity of cytochrome C oxidase (COX) and superoxide dismutase and expression of uncoupling protein 2, voltage-dependent anion channel 1, and Bcl 2 were upregulated and SLC25A6, MDA levels were downregulated. Additionally, our findings indicated that electroacupuncture pre-treatment of PC6 point exerted an effect on the mitochondria via the mitochondrial-transcription-factor-A/nuclear-respiratory-factor-1/proliferator-activated-receptor-gamma-coactivator-1 pathway. Conclusion The present study revealed that electroacupuncture pre-treatment of PC6 could effectively alleviate bupivacaine-induced myocardial mitochondrial damage, thereby providing a theoretical basis for clinical studies and applications of this treatment method.
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Affiliation(s)
- Chunai Wang
- Gansu Provincial Hospital of Traditional Chinese Medicine, No. 424, Guazhou Road, Qilihe District, Lanzhou, 730050, Gansu, China.
| | - Xi Liang
- Gansu Provincial Hospital of Traditional Chinese Medicine, No. 424, Guazhou Road, Qilihe District, Lanzhou, 730050, Gansu, China
| | - Yan Yu
- Gansu Provincial Hospital of Traditional Chinese Medicine, No. 424, Guazhou Road, Qilihe District, Lanzhou, 730050, Gansu, China
| | - Yulan Li
- The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiaohui Wen
- Gansu University of Chinese Medicine, Lanzhou, Gansu, China
| | - Min Liu
- Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China
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