Amnesic Concentrations of the Nonimmobilizer 1,2-Dichlorohexafluorocyclobutane (F6, 2N) and Isoflurane Alter Hippocampal θ Oscillations In Vivo

Background: Drug-induced temporary amnesia is one of the principal goals of general anesthesia. The nonimmobilizer 1,2-dichlorohexafluorocyclobutane (F6, also termed 2N) impairs hippocampus-dependent learning at relative, i.e., lipophilicity-corrected, concentrations similar to isoflurane. Hippocampal [theta] oscillations facilitate mnemonic processes in vivo and synaptic plasticity (a cellular model of memory) in vitro and are thought to represent a circuit level phenomenon that supports memory encoding. Therefore, the authors investigated the effects of F6 and isoflurane on [theta] oscillations (4-12 Hz).

Methods: Thirteen adult rats were implanted with multichannel depth electrodes to measure the microelectroencephalogram and were exposed to a range of concentrations of isoflurane and F6 spanning the concentrations that produce amnesia. Five of these animals also underwent control experiments without drug injection. The authors recorded the behavioral state and hippocampal field potentials. They confirmed the electrode location postmortem by histology.

Results: The tested concentrations for isoflurane and F6 ranged from 0.035% to 0.77% and from 0.5% to 3.6%, respectively. Isoflurane increased the fraction of time that the animals remained immobile, consistent with sedation, whereas F6 had the opposite effect. Electroencephalographic power in the [theta] band was less when the animals were immobile than when they explored their environment. F6 suppressed the power of oscillations in the [theta] band. Isoflurane slowed [theta] oscillations without reducing total power in the [theta] band.     

Contemporary anesthesia ventilators incur a significant “oxygen cost”

Purpose

Anesthesia ventilators use oxygen or oxygen/air mixtures to drive the bellows during controlled ventilation. As a practitioner may find himself in a situation that the only available oxygen source is a compressed oxygen cylinder, it is important to know the oxygen consumption of anesthesia ventilators during controlled ventilation.

Methods

We tested the Datex-Ohmeda 7900 ventilator mounted on an Excel 210 anesthesia machine under a variety of conditions. For comparison, we also tested the Ohmeda 7800 and the Dräger AV-2 ventilator under control conditions. All experiments were performed using a test lung.

Results

The oxygen consumption of the AV-2 and the Datex-Ohmeda ventilators averaged 302 ± 17 L·hr^?1 and 564 ± 68 to 599 ± 56 L·hr^?1, respectively (P < 0.01 AV-2vs 7800 and 7900). When using an E-type cylinder, this would result in a mean time to alarm of 93 min and 54 to 57 min, respectively. Decreased lung compliance increased the oxygen consumption to 848 ± 16 L·hr^?1.

Conclusions

Machine-driven mechanical ventilation incurs a significant “oxygen cost.” We show that the amount of oxygen consumed by mechanical ventilation with contemporary anesthesia ventilators is influenced by patient-dependent factors and may greatly exceed the amount of oxygen delivered to the patient.     

Amnesic concentrations of the nonimmobilizer 1,2-dichlorohexafluorocyclobutane (F6, 2N) and isoflurane alter hippocampal theta oscillations in vivo

BACKGROUND: Drug-induced temporary amnesia is one of the principal goals of general anesthesia. The nonimmobilizer 1,2-dichlorohexafluorocyclobutane (F6, also termed 2N) impairs hippocampus-dependent learning at relative, i.e., lipophilicity-corrected, concentrations similar to isoflurane. Hippocampal theta oscillations facilitate mnemonic processes in vivo and synaptic plasticity (a cellular model of memory) in vitro and are thought to represent a circuit level phenomenon that supports memory encoding. Therefore, the authors investigated the effects of F6 and isoflurane on theta oscillations (4-12 Hz). METHODS: Thirteen adult rats were implanted with multichannel depth electrodes to measure the microelectroencephalogram and were exposed to a range of concentrations of isoflurane and F6 spanning the concentrations that produce amnesia. Five of these animals also underwent control experiments without drug injection. The authors recorded the behavioral state and hippocampal field potentials. They confirmed the electrode location postmortem by histology. RESULTS: The tested concentrations for isoflurane and F6 ranged from 0.035% to 0.77% and from 0.5% to 3.6%, respectively. Isoflurane increased the fraction of time that the animals remained immobile, consistent with sedation, whereas F6 had the opposite effect. Electroencephalographic power in the theta band was less when the animals were immobile than when they explored their environment. F6 suppressed the power of oscillations in the theta band. Isoflurane slowed theta oscillations without reducing total power in the theta band. CONCLUSIONS: Drug-induced changes in theta oscillations may be a common basis for amnesia produced by F6 and isoflurane. The different patterns suggest that these drugs alter network activity by acting on different molecular and/or cellular targets.     

Myocardial infarction after vascular surgery: the role of prolonged stress-induced, ST depression-type ischemia

OBJECTIVES: The goal of this study was to investigate the nature of the association between silent ischemia and postoperative myocardial infarction (PMI). BACKGROUND: Silent ischemia predicts cardiac morbidity and mortality in both ambulatory and postoperative patients. Whether silent stress-induced ischemia is merely a marker of extensive coronary artery disease or has a closer association with infarction has not been determined. METHODS: In 185 consecutive patients undergoing vascular surgery, we correlated ischemia duration, as detected on a continuous 12-lead ST-trend monitoring during the period 48 h to 72 h after surgery, with cardiac troponin-I (cTn-I) measured in the first three postoperative days and with postoperative cardiac outcome. Postoperative myocardial infarction was defined as cTn-I >3.1 ng/ml accompanied by either typical symptoms or new ischemic electrocardiogram (ECG) findings. RESULTS: During 11,132 patient-hours of monitoring, 38 patients (20.5%) had 66 transient ischemic events, all but one denoted by ST-segment depression. Twelve patients (6.5%) sustained PMI; one of those patients died. All infarctions were non-Q-wave and were detected by a rise in cTn-I during or immediately after prolonged, ST depression-type ischemia. The average duration ofischemia in patients with PMI was 226+/-164 min (range: 29 to 625), compared with 38+/-26 min (p = 0.0000) in 26 patients with ischemia but not infarction. Peak cTn-I strongly correlated with the longest, as well as cumulative, ischemia duration (r = 0.83 and r = 0.78, respectively). Ischemic ECG changes were completely reversible in all but one patient who had persistent new T wave inversion. All ischemic events culminating in PMI were preceded by an increase in heart rate (delta heart rate = 32+/-15 beats/min), and most (67%) of them began at the end of surgery and emergence from anesthesia. CONCLUSIONS: Prolonged, ST depression-type ischemia progresses to MI and is strongly associated with the majority of cardiac complications after vascular surgery.     

Presynaptic and postsynaptic actions of halothane at glutamatergic synapses in the mouse hippocampus

1. Whole-cell patch-clamp recordings in adult mouse hippocampal slices were used to test the mechanism by which the volatile anesthetic halothane inhibits glutamate receptor-mediated synaptic transmission. Non-N-methyl-D-aspartate (nonNMDA) and NMDA receptor-mediated currents in CA1 pyramidal cells were pharmacologically isolated by bath application of D,L-2-amino-5-phosphonovaleric acid (APV; 100 μM) or 6-cyano-7-nitro-quinoxaline-2,3-dione (CNQX; 5 μM), respectively.
2. Halothane blocked both nonNMDA and NMDA receptor-mediated excitatory postsynaptic currents (EPSCs) to a similar extent (IC₅₀ values of 0.66 and 0.57 mM, respectively).
3. Partial blockade of the EPSCs by lowering the extracellular concentration of calcium ([Ca²⁺]_o), but not by application of CNQX (1 μM), was accompanied by an increase in paired-pulse facilitation (PPF). Halothane-induced blockade of the EPSCs also was associated with an increase in PPF.
4. The effects of halothane on α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) and NMDA receptor-mediated currents induced by agonist iontophoresis, were compared. AMPA-induced currents were blocked with an IC₅₀ of 1.7 mM. NMDA-induced currents were significantly less sensitive to halothane (IC₅₀ of 5.9 mM).
5. The effect of halothane on iontophoretic AMPA dose-response curves was tested. Halothane suppressed the maximal response to AMPA without affecting its EC₅₀, suggesting a noncompetitive mechanism of inhibition.
6. All effects of halothane were reversible upon termination of the exposure to the drug.
7. These data suggest that halothane blocks central glutamatergic synaptic transmission by presynaptically inhibiting glutamate release and postsynaptically blocking the AMPA subtype of glutamate receptors.

     

Non-immobilizing inhalational anesthetic-like compounds

Nonimmobilizing, inhalational anesthetic-like compounds are experimental agents developed as a tool to investigate the mechanism of action of general anesthetics. Clinically used for more than 150 years, general anesthesia has until now defied all attempts to formulate a theory of its mechanisms that would link, in an uninterrupted logical chain, observations on the molecular level-via effects on the cellular and network levels-to the in vivo phenomenon. Nonimmobilizers, initially termed nonanesthetics, are substances that disobey the Meyer-Overton rule. Theoretically, in appropriately designed experiments, nonanesthetics can serve as a type of Ockham's razor to separate important from irrelevant observations: processes that, at comparable concentrations, are affected to a similar degree by inhalational anesthetics and by nonanesthetics, do not contribute to anesthesia (the nonanesthetic algorithm). In practice, however, this appealing algorithm has been rather difficult to apply. On one hand, nonanesthetics are not inert on the behavioral level: they cause, inter alia, amnesia. This discovery required not only the introduction of the more precise term "nonimmobilizers," but also excluded one important component of anesthesia, i.e., amnesia, from application of the algorithm. On the other hand, compared to inhalational anesthetics, nonimmobilizers interact with relatively few molecular targets, also limiting the usefulness of the nonimmobilizer algorithm. Nevertheless, nonimmobilizers have not only yielded useful results but can, by virtue of those very properties that make them less than ideal for anesthesia research, be used as experimental tools in the neurosciences far beyond anesthetic mechanisms.