Analgesia with sevoflurane during labour: I. Determination of the optimum concentration

Yeo, S.T.; Holdcroft, Anita; Yentis, Steve; Stewart, Adrienne

doi:10.1093/bja/ael326

Cited by 39 publications

(23 citation statements)

References 22 publications

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“…The changes in behavior and c-Fos expression following xenon or sevoflurane administration are similar to the effects of epidural analgesia with morphine [7], suggesting that both 35% xenon and 0.35% sevoflurane exert antinociceptive effect during labor in rats. A clinical trial showed the best concentration of sevoflurane for labor analgesia was 0.8% and, though sedation was noticed, it was safe and associated with higher maternal satisfaction than nitrous oxide [14]. In our pilot studies we saw severe sedation of the dams and delayed labor with sevoflurane concentrations >0.5%.…”

Section: Discussionmentioning

confidence: 72%

Xenon and Sevoflurane Provide Analgesia during Labor and Fetal Brain Protection in a Perinatal Rat Model of Hypoxia-Ischemia

et al. 2012

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It is not possible to identify all pregnancies at risk of neonatal hypoxic-ischemic encephalopathy (HIE). Many women use some form of analgesia during childbirth and some anesthetic agents have been shown to be neuroprotective when used as analgesics at subanesthetic concentrations. In this study we sought to understand the effects of two anesthetic agents with presumptive analgesic activity and known preconditioning-neuroprotective properties (sevoflurane or xenon), in reducing hypoxia-induced brain damage in a model of intrauterine perinatal asphyxia. The analgesic and neuroprotective effects at subanesthetic levels of sevoflurane (0.35%) or xenon (35%) were tested in a rat model of intrauterine perinatal asphyxia. Analgesic effects were measured by assessing maternal behavior and spinal cord dorsal horn neuronal activation using c-Fos. In separate experiments, intrauterine fetal asphyxia was induced four hours after gas exposure; on post-insult day 3 apoptotic cell death was measured by caspase-3 immunostaining in hippocampal neurons and correlated with the number of viable neurons on postnatal day (PND) 7. A separate cohort of pups was nurtured by a surrogate mother for 50 days when cognitive testing with Morris water maze was performed. Both anesthetic agents provided analgesia as reflected by a reduction in the number of stretching movements and decreased c-Fos expression in the dorsal horn of the spinal cord. Both agents also reduced the number of caspase-3 positive (apoptotic) neurons and increased cell viability in the hippocampus at PND7. These acute histological changes were mirrored by improved cognitive function measured remotely after birth on PND 50 compared to control group. Subanesthetic doses of sevoflurane or xenon provided both analgesia and neuroprotection in this model of intrauterine perinatal asphyxia. These data suggest that anesthetic agents with neuroprotective properties may be effective in preventing HIE and should be tested in clinical trials in the future.

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Section: Discussionmentioning

confidence: 72%

Xenon and Sevoflurane Provide Analgesia during Labor and Fetal Brain Protection in a Perinatal Rat Model of Hypoxia-Ischemia

et al. 2012

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“…It is possible that higher doses of sevoflurane may have had an enhanced effect, but they also would have limited clinical translation, because maternal sedation is a significant complication of sevoflurane at concentrations in excess of 0.8%. 18 In aggregate, a preconditioning dose of sevoflurane alone during labor does not seem to be a clinically acceptable option.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Volatile anesthetics, such as sevoflurane, have also been shown to protect myocardium from ischemic injury in a preconditioning setting. 16,17 Furthermore, sevoflurane (0.8% in oxygen) has recently been shown to provide labor analgesia that is superior to that of nitrous oxide (50%)-oxygen 18 ; however, it is unknown whether sevoflurane can precondition against perinatal asphyxial injury like xenon can. 14 The inert gas xenon is an N-methyl-D-aspartate receptor antagonist, whereas sevoflurane acts mainly via ␥-aminobutyric acid type A receptors.…”

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confidence: 99%

Xenon and Sevoflurane Protect against Brain Injury in a Neonatal Asphyxia Model

Luo

Ieong

et al. 2008

Anesthesiology

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Background: Perinatal hypoxia-ischemia causes significant morbidity and mortality. Xenon and sevoflurane may be used as inhalational analgesics for labor. Therefore, the authors investigated the potential application of these agents independently and in combination to attenuate perinatal injury.Methods: Oxygen-glucose deprivation injury was induced in pure neuronal or neuronal-glial cocultures 24 h after preconditioning with xenon and/or sevoflurane. Cell death was assessed by lactate dehydrogenase release or staining with annexin V-propidium iodide. The mediating role of phosphoinositide-3-kinase signaling in putative protection was assessed using wortmannin, its cognate antagonist. In separate in vivo experiments, perinatal asphyxia was induced 4 hours after preconditioning with analgesic doses alone and in combination; infarct size was assessed 7 days later, and neuromotor function was evaluated at 30 days in separate cohorts. The role of phosphorylated cyclic adenosine monophosphate response element binding protein in the preconditioning was assessed by immunoblotting.Results: Both anesthetics preconditioned against oxygen-glucose deprivation in vitro alone and in combination. The combination increased cellular viability via phosphoinositide-3-kinase signaling. In in vivo studies, xenon (75%) and sevoflurane (1.5%) alone as well as in combination (20% xenon and 0.75% sevoflurane) reduced infarct size in a model of neonatal asphyxia. Preconditioning with xenon and the combination of xenon and sevoflurane resulted in long-term functional neuroprotection associated with enhanced phosphorylated cyclic adenosine monophosphate response element binding protein signaling.Conclusions: Preconditioning with xenon and sevoflurane provided long-lasting neuroprotection in a perinatal hypoxicischemic model and may represent a viable method to preempt neuronal injury after an unpredictable asphyxial event in the perinatal period.

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“…Specifically, inhalational agents decrease postoperative surgical pain and obtund uncomfortable sensory input originating from contractions of the bladder muscles caused by activation of muscarinic receptors-sevoflurane provides effective analgesia for visceral pain. [22][23][24] Fourth, there is a limitation in generalizing our results because various patient populations with different CRBD triggers were not included in this study. In other words, CRBD can be triggered by various factors, including foreign bodies in the bladder, cauterization of the bladder mucosa, intravesical chemotherapy, and bladder sutures.…”

Section: Discussionmentioning

confidence: 99%

The effect of sevoflurane versus desflurane on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of a bladder tumour: a randomized controlled trial

Kim

Hong

Lim

et al. 2016

Can J Anesth/J Can Anesth

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Analgesia with sevoflurane during labour: I. Determination of the optimum concentration

Abstract: We concluded that the optimal sevoflurane concentration in labour was 0.8%. This concentration allows a safety margin and balances the risk of sedation with the benefit of pain relief in labour.

Cited by 39 publications

References 22 publications

Xenon and Sevoflurane Provide Analgesia during Labor and Fetal Brain Protection in a Perinatal Rat Model of Hypoxia-Ischemia

Xenon and Sevoflurane Provide Analgesia during Labor and Fetal Brain Protection in a Perinatal Rat Model of Hypoxia-Ischemia

Xenon and Sevoflurane Protect against Brain Injury in a Neonatal Asphyxia Model

The effect of sevoflurane versus desflurane on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of a bladder tumour: a randomized controlled trial

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