Gene and systemic inflammatory effects and neuroendocrine response in surgical patients anesthetized with desflurane-nitrous oxide or desflurane-nitrous oxide-free: A randomized trial

Arruda, Nayara M.; Braz, Leandro Gobbo; Nogueira, Flávia R.; Souza, Kátina M.; Aun, Aline G.; Carvalho, Lídia Raquel de; Bráz, José Reinaldo Cerqueira; Braz, Mariana Gobbo

doi:10.1016/j.intimp.2020.107163

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…Some studies have shown that it may be associated with apoptosis in the developing brain and may inhibit major enzymatic pathways leading to neurological damage, 35 although the evidence for damage in humans is inconclusive. Similarly, there have been controversial findings regarding possible immunologic effects of, but recent research has shown that it does not affect the inflammatory and neuroendocrine response of anesthetized patients 36 . Last, it is well known that the irreversible inhibition of cyanocobalamin (vitamin B12) by N 2 O can lead to hematological and neurological toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, there have been controversial findings regarding possible immunologic effects of, but recent research has shown that it does not affect the inflammatory and neuroendocrine response of anesthetized patients. 36 Last, it is well known that the irreversible inhibition of cyanocobalamin (vitamin B12) by Another issue with the use of inhalation anesthesia, especially with N 2 O in pediatrics, is the possibility of nausea and vomiting, which occur with a frequency of 0%-26%, depending on whether it has been administered by itself or with other drugs. 40 In our experience, this complication did not occur frequently (0.8%).…”

Section: Re Sultsmentioning

confidence: 99%

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Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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IntroductionProton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols.MethodsWe reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway.ResultsOf the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non‐serious adverse effects was 0.7% (Clopper–Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper–Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches.ConclusionInhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.

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Section: Discussionmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

García‐Aroca,

Fernández‐de Miguel,

Franceschi

et al. 2023

Pediatric Anesthesia

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“…Overall, there are controversial findings in relation to certain inhalational anesthetics, including halogenated isoflurane and desflurane, and their possible modulation of gene expression in surgical patients (Arruda et al, 2019, 2021; Braz et al, 2011a; Freire et al, 2018). Hence, there is growing interest with respect to understanding the possible role of anesthetics on mRNA (Alexa et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

“…Overall, there are controversial findings in relation to certain inhalational anesthetics, including halogenated isoflurane and desflurane, and their possible modulation of gene expression in surgical patients (Arruda et al, 2019(Arruda et al, , 2021Braz et al, 2011a;Freire et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Modulation of gene expression and inflammation but not DNA damage after sevoflurane anesthesia

Silva

Braz

Bráz

et al. 2023

Environ and Mol Mutagen

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This study assessed, for the first time, the expression of the genes hOGG1, TP53, and IL‐6 in leukocytes by real‐time quantitative polymerase chain reaction in surgical patients before (baseline), during (2 h of anesthesia) and 1 day after sevoflurane anesthesia. Additionally, DNA damage was detected by the comet assay, serum interleukin (IL)‐6 was detected by flow cytometry, and differential leukocyte counting was also performed. TP53 and hOGG1 expression was downregulated on the day after anesthesia compared to before anesthesia. However, IL‐6 expression did not change, and no DNA damage induction was observed during or after anesthesia. At the systemic level, mild neutrophilia and an increase in IL‐6 levels occurred after anesthesia. Our findings suggest that sevoflurane anesthesia downregulates gene expression (hOGG1 and TP53) and contributes to an inflammatory status (increased systemic IL‐6 and mild neutrophilia) but is not associated with DNA damage in patients without comorbidities who undergo minor elective surgery.

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“…Anesthetic drugs have discrepant effects on patients' immune milieu, desflurane alone or with NO 2 cause significant increase in systemic interleukin (IL)-6 one day after surgery [7]. On contrary, sevoflurane can attenuate the inflammatory response during cardiopulmonary bypass [8] and dexmedetomidine, in ischemia-perfusion animal model, decreased levels of IL-1β, IL-6 and tumor necrosis factor-α (TNF-α) [9].…”

Section: Introductionmentioning

confidence: 99%

Continuous midazolam infusion can minimize the pro-inflammatory response to anesthesia and surgery for pediatric patients with intra-abdominal infection: Comparative study versus continuous propofol infusion

Lotfy¹,

Ayaad

Elsawaf

et al. 2021

Egyptian Journal of Anaesthesia

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Gene and systemic inflammatory effects and neuroendocrine response in surgical patients anesthetized with desflurane-nitrous oxide or desflurane-nitrous oxide-free: A randomized trial

Cited by 5 publications

References 29 publications

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Inhalation anesthesia without any intravenous management for pediatric proton beam therapy

Modulation of gene expression and inflammation but not DNA damage after sevoflurane anesthesia

Continuous midazolam infusion can minimize the pro-inflammatory response to anesthesia and surgery for pediatric patients with intra-abdominal infection: Comparative study versus continuous propofol infusion

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