Duplicate preconditioning with sevoflurane in vitro improves neuroprotection in rat brain via activating the extracellular signal-regulated protein kinase

Objective

Sevoflurane preconditioning has been demonstrated to reduce cerebral ischemia-reperfusion (IR) injury, but the underlying mechanisms have not been fully elucidated. Besides, different protocols would usually lead to different results. The objective of this study was to determine whether dual exposure to sevoflurane improves the effect of anesthetic preconditioning against oxygen and glucose deprivation (OGD) injury in vitro.

Methods

Rat hippocampal slices under normoxic conditions (95% O₂/5% CO₂) were pre-exposed to sevoflurane 1, 2 and 3 minimum alveolar concentration (MAC) for 30 min, once or twice, with 15-min washout after each exposure. The slices were then subjected to 13-min OGD treatment (95% N₂/5% CO₂, glucose-free), followed by 30-min reoxygenation. The population spikes (PSs) were recorded in the CA1 region of rat hippocampus. The percentage of PS amplitude at the end of 30-min reoxygenation to that before OGD treatment was calculated, since it could indicate the recovery degree of neuronal function. In addition, to assess the role of mitogen-activated protein kinases (MAPKs) in preconditioning, U0126, an inhibitor of extracellular signal-regulated protein kinase (MEK-ERK1/2, ERK1/2 MAPK), and SB203580, an inhibitor of p38 MAPK, were separately added 10 min before sevoflurane exposure.

Results

Preconditioning once with sevoflurane 1, 2, and 3 MAC increased the percentage of PS amplitude at the end of 30-min reoxygenation to that before OGD treatment, from (15.13±3.79)% (control) to (31.88±5.36)%, (44.00±5.01)%, and (49.50±6.25)%, respectively, and twice preconditioning with sevoflurane 1, 2, and 3 MAC increased the percentage to (38.53±4.36)%, (50.74±7.05)% and (55.86±6.23)%, respectively. The effect of duplicate preconditioning with sevoflurane 3 MAC was blocked by U0126 [(16.23±4.62)%].

Conclusion

Sevoflurane preconditioning can induce neuroprotection against OGD injury in vitro, and preconditioning twice enhances this effect. Besides, the activation of extracellular signal-regulated protein kinase (MEK-ERK1/2, ERK1/2 MAPK) may be involved in this process.     

全麻复合硬膜外麻醉对非体外循环冠脉搭桥围术期循环功能及心肌酶变化的影响

目的分析全麻复合硬膜外麻醉对非体外循环冠状动脉搭桥(OPCAB)术中循环功能及及心肌酶变化的影响.方法30例择期行非体外循环冠脉搭桥术病人按随机分为两组观察组为高位胸段硬膜外阻滞复合全麻;对照组为单纯全麻,在麻醉诱导前(TO)、术后1 h(T1)、24h(T2)、48 h(T3)4个时间点抽取血样测定eTnI、CK、CK-MB值并记录血流动力学指标.结果所有病人手术经过及术后恢复顺利,无1例转为体外循环.术前两组间各项指标差异均无统计学意义(P＞0.05).但术后观察组血压、心率较对照组为平稳.对照组病人术后血压、心率均较观察组明显升高(P＜0.05);两组术后各时点CK、CK-MB、cTnJ均较术前明显升高(P＜0.05).与对照组相比,观察组术后各时点明显降低(P＜0.05).观察组气管拔管时间、ICU停留时间及术后住院天数均较对照组明显缩短.结论硬膜外复合全麻可以使循环功能稳定,为OPCAB围术期心肌提供良好保护作用.     

咪唑安定清醒镇静在椎管内麻醉中的应用观察

苯二氮革类药物具有抗焦虑、镇静、遗忘、肌松和抗惊厥作用[1]。咪唑安定是一种强效的水溶性苯二氮草类药,局部注射疼痛少,催眠起效快,维持时间短,消除速率快,安全系数大,适宜作清醒镇静。常在局麻或部位麻醉中用来抗焦虑,减少术中知晓,提     

气管巨大肿物切除的麻醉体会

气管肿物患者术前有不同程度通气障碍,麻醉处理应周密计划。特别是肿物巨大、占据气管管腔大部分者,更给麻醉处理带来棘手问题,现结合病例浅谈此类麻醉的体会。     

星状神经节阻滞术对围术期心血管反应的影响

围术期心血管反应主要为应激反应所致,应激是指机体在受到各种强烈因素（即应激原）刺激时所出现的以交感神经兴奋和垂体-肾上腺皮质分泌增多为主的一系列神经内分泌反应,以及由此而引起的各种机能和代谢的改变[1]。强烈的应激可产生很多非特异的病理生理改变,对机体产生不利影响,     

JNK信号通路在异氟醚预处理和七氟醚预处理减轻大鼠海马脑片缺氧无糖损伤中的作用

目的 评价c-Jun氨基末端激酶(JNK)信号通路在异氟醚预处理和七氟醚预处理减轻大鼠海马脑片缺氧无糖(OGD)损伤中的作用.方法雄性成年SD大鼠,体重270～290 g,断头处死,剥离海马,制备海马脑片.取大鼠海马脑片96张,采用随机数字表法,将其随机分为8组(n=12):对照组(C组)、OGD组、异氟醚预处理组(Iso组)、七氟醚预处理组(Sevo组)、SP600125+异氟醚预处理组(SP+Iso组)、SP600125+七氟醚预处理组(SP+Sevo组)、二甲基亚砜(DMSO)+异氟醚预处理组(DMSO+Iso组)和DMSO+七氟醚预处理组(DMSO+Sevo组).采用电生理技术,细胞外记录CA1区群锋电位(PS)波幅,计算PS恢复程度.采用碘化丙啶染色法,测定细胞活力.结果 与C组比较,其余各组PS恢复程度和细胞活力降低(P＜0.01);与OGD组比较,Iso组、Sevo组、SP+Iso.组、SP+Sevo组、DMSO+Iso组和DMSO+Sevo组PS恢复程度和细胞活力升高(P＜0.01);与180组比较,SP+Iso组PS恢复程度和细胞活力升高(P＜0.01),DMSO+Iso组PS恢复程度和细胞活力差异无统计学意义(P＞0.05);与Sevo组比较,SP+Sevo组PS恢复程度和细胞活力升高(P＜0.01),DMSO+Sevo组PS恢复程度和细胞活力差异无统计学意义(P＞0.05).结论 异氟醚预处理和七氟醚预处理可通过抑制JNK信号通路,减轻大鼠海马脑片缺氧无糖损伤.

Abstract：

Objective To evaluate the role of c-Jun N-terminal kinase (JNK) signaling pathway in the protective effect of isoflurane preconditioning and sevoflurane preconditioning against oxygen-glucose deprivation (OGD) injury in rat hippocampal slices. Methods Male adult SD rats weighing 270-290 g were anesthetized with ether and decapitated. The hippocampi were removed and sagittally sliced (400 μm thick) and placed in artificial cerebral spinal fluid aerated with 95% O2-5% CO2 . Ninety-six hippocampal slices were randomly divided into 8 groups (n = 12 each): control group (group C), OGD group, isoflurane preconditioning group (group Iso),sevoflurane preconditioning group (group Sevo) , SP600125 + isoflurane preconditioning group (group SP + Iso),SP600125 +sevoflurane preconditioning group (group SP + Sevo), DMSO + isoflurane preconditioning group (group DMSO + Iso) and DMSO + sevoflurane preconditioning group (group DMSO + Sevo). Electrophysiological technique was used to record the amplitude of population spike ( PS) in the stratum pyramidale of CA1 region and the degree of recovery of PS was calculated. The cell viability was determined by propidium iodide staining. Results Compared with group C, the degree of recovery of PS and cell viability were significantly decreased in the other groups ( P ＜ 0.01) . Compared with group OGD, the degree of recovery of PS and cell viability were significantly increased in groups Iso, Sevo, SP+Iso, SP+Sevo, DMSO+ Iso and DMSO + Sevo (P＜ 0.01). Compared with group Iso, the degree of recovery of PS and cell viability were significantly increased in group SP+Iso ( P ＜ 0.01) , while no significant change was found in group DMSO + Iso ( P ＞ 0.05) . Compared with group Sevo, the degree of recovery of PS and cell viability were significantly increased in group SP + Sevo ( P ＜ 0.01) , while no significant change was found in group DMSO + Sevo ( P ＞ 0.05). Conclusion Isoflurane preconditioning and sevoflurane preconditioning can attenuate the OGD injury to rat hippocampal slices through inhibiting JNK signaling pathway.     

小剂量芬太尼复合七氟醚麻醉在脱泵冠脉旁路移植术中的应用

目的观察小剂量芬太尼（20μg／kg）复合七氟醚麻醉在脱泵冠脉旁路移植术（OPCABG）中的应用价值。方法48例OPCABG的病人随机分为两组（n=24）,A组芬太尼用量20μg／kg、辅以1％-3％七氟醚持续吸入;B组芬太尼用量50μg／kg。其他麻醉诱导、维持方法相同。常规监测血压、心率,心电图和脉搏氧饱和度（SPO2）。于麻醉前、插管后、劈胸骨、血管移植后和手术结束检测血糖、血浆促肾上腺皮质激素（ACTH）和皮质醇,并记录术后气管拔管时间。结果两组病人各时点血压、心率比较差异没统计学意义（P〉0．05）;血糖、ACTH和皮质醇变化相似（P〉0．05）。但A组气管拔管时间缩短（P〈0．05）。结论与传统大剂量芬太尼麻醉相比,小剂量芬太尼复合七氟醚麻醉在0PCABG中可以维持血流动力学稳定,适当控制应激反应并缩短术后气管拔管时间。     

10例腹腔镜嗜铬细胞瘤手术的围术期麻醉管理体会

目的：探讨腹腔镜下嗜铬细胞瘤手术的围术期麻醉管理方法。方法：回顾性分析2007年7月～2010年5月石河子大学医学院第一附属医院10例嗜铬细胞瘤手术的围术期麻醉管理,分析麻醉过程中监测指标的变化及术后恢复情况。结果：分离肿瘤时DBP、SBP较麻醉前升高,HR增快,差异有统计学意义（P〈0.05）;肿瘤切除后DBP、SBP及HR同分离肿瘤时比较,差异有统计学意义（P〈0.05）。术毕苏醒迅速,术后随访无麻醉并发症,均康复出院。结论：充分的术前准备,严密的术中管理,完善的监测,以及术后后续监测及治疗,是保证此类患者生命安全的关键。     

舒芬太尼复合七氟醚麻醉对非体外循环冠脉搭桥术血流动力学和应激的影响

引言 非体外循环冠脉搭桥（OPCABG）不停跳、无需心肺转流、对血流动力学干扰和应激相对轻的特点,使传统大剂量芬太尼麻醉的主导地位发生了动摇。舒芬太尼和七氟醚是近年应用于心脏手术麻醉的药物,在OPCABG中的应用经验还很少．我们观察小剂量舒芬太尼复合七氟醚麻醉对OP—CABG血流动力学和应激反应的影响,评价其麻醉效果和临床应用价值．     

MED系统腰椎间盘切除术的麻醉处理探讨

MED(MicroEndoscopicDisectomy)椎板间隙入路椎间盘切除术九十年代中后期兴起于美国。该术式结合了开放式和显微手术的优点而较快推广应用。其麻醉方法由传统逐渐趋向于特殊要求。我院于2 0 0 2年 5月～ 2 0 0 3年 2月共实施该类手术的麻醉2 0例 ,全部采用硬膜外阻滞麻醉取得成功。现就麻醉处理的特殊性总结报告如下。1　资料和方法1 1　资料　本组 2 0例 ,男 9例 ,女 11例 ,年龄 2 1～6 6岁。单间隙突出 19例 ,其中腰4 - 5突出 13例 ,腰5-骶1突出 6例 ,腰2 - 3、腰3- 4双间隙突出 1例。1 2　方法1 2 1　麻醉前用药　麻醉前 1小时肌注苯…