Anesthesia and analgesia
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Anesthesia and analgesia · May 2016
Right Ventricular Longitudinal Strain Is Depressed in a Bovine Model of Pulmonary Hypertension.
Pulmonary hypertension and resulting right ventricular (RV) dysfunction are associated with significant perioperative morbidity and mortality. Although echocardiography permits real-time, noninvasive assessment of RV function, objective and comparative measures are underdeveloped, and appropriate animal models to study their utility are lacking. Longitudinal strain analysis is a novel echocardiographic method to quantify RV performance. Herein, we hypothesized that peak RV longitudinal strain would worsen in a bovine model of pulmonary hypertension compared with control animals. ⋯ Peak longitudinal RV strain detected worsened RV function in animals with hypoxia-induced pulmonary hypertension compared with control animals. This relationship was demonstrated in the transthoracic echocardiographic 4-chamber view independently for the RV free wall and for the combination of the free and septal walls. This innovative model of bovine pulmonary hypertension may prove useful to compare different monitoring technologies for the assessment of early events of RV dysfunction. Further studies linking novel RV imaging applications with mechanistic and therapeutic approaches are needed.
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The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs. ⋯ Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.
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Anesthesia and analgesia · May 2016
High Glucose Attenuates Anesthetic Cardioprotection in Stem-Cell-Derived Cardiomyocytes: The Role of Reactive Oxygen Species and Mitochondrial Fission.
Hyperglycemia can blunt the cardioprotective effects of isoflurane in the setting of ischemia-reperfusion injury. Previous studies suggest that reactive oxygen species (ROS) and increased mitochondrial fission play a role in cardiomyocyte death during ischemia-reperfusion injury. To investigate the role of glucose concentration in ROS production and mitochondrial fission during ischemia-reperfusion (with and without anesthetic protection), we used the novel platform of human-induced pluripotent stem-cell (iPSC)-derived cardiomyocytes (CMs). ⋯ Human iPSC-CM is a useful, relevant model for studying isoflurane cardioprotection and can be manipulated to recapitulate complex clinical perturbations. We demonstrate that the cardioprotective effects of isoflurane in elevated glucose conditions can be restored by scavenging ROS or inhibiting mitochondrial fission. These findings may contribute to further understanding and guidance for restoring pharmacological cardioprotection in hyperglycemic patients.
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Anesthesia and analgesia · May 2016
The Sounds of Desaturation: A Survey of Commercial Pulse Oximeter Sonifications.
The pulse oximeter has been a standard of care medical monitor for >25 years. Most manufacturers include a variable-pitch pulse tone in their pulse oximeters. Research has shown that the acoustic properties of variable-pitch tones are not standardized. In this study, we surveyed the properties of pulse tones from 21 pulse oximeters, consisting of 1 to 4 instruments of 11 different models and 8 brands. Our goals were to fully document the sounds over saturation values 0% to 100%, test whether tones become quieter at low saturation values, and create a public repository of pulse oximeter recordings for future use. ⋯ Current pulse oximeters use different techniques to address the competing goals of (1) using pitch steps that are large enough to be readily perceived, and (2) conveying saturation values from 0 to 100 within a limited range of sound frequencies. From a clinical perspective, 2 techniques for increasing perceivability (increasing the frequency range and using ratio step sizes) have no drawback, but 2 techniques (not changing pitch at every saturation change and using a lower saturation cutoff) do have potential clinical drawbacks. On the basis of our findings, we have made suggestions for clinicians and manufacturers.
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Anesthesia and analgesia · May 2016
Emulsified Isoflurane Protects Against Transient Focal Cerebral Ischemia Injury in Rats via the PI3K/Akt Signaling Pathway.
Phosphoinositide-3-kinase (PI3K)/protein kinase B (Akt) pathway activation may promote neuronal survival via neuroprotection during inflammation after cerebral ischemia. In this study, we investigated whether IV pretreatment with emulsified isoflurane (EI) could decrease ischemic brain injury related to the PI3K/Akt pathway. ⋯ These findings suggest that EI pretreatment protects against ischemic brain injury via the inhibition of cerebral inflammation and is associated with the PI3K-Akt pathway in rats with MCAO. This drug may be a novel therapeutic agent for patients after stroke.