Monitoring of brain oxygenation in surgery of ruptured middle cerebral artery aneurysms

Cerejo, António; Silva, Pedro Alberto; Dias, Celeste; Vaz, Ruí

doi:10.4103/2152-7806.81732

Cited by 17 publications

(11 citation statements)

References 17 publications

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“…Propofol protects neuronal cells from hypoxia reoxygenation injury, possibly via a combined direct antioxidant effect along with induced cellular antioxidant mechanisms. Hypoxia and re-oxygenation events occur under various clinical conditions including intra-and peri-operative brain ischaemia [1][2][3][4][5]. In the brain, hypoxia re-oxygenation often leads to severe cellular damage resulting in a loss of neurological function and a poor clinical outcome [6][7][8].…”

mentioning

confidence: 99%

Effect of propofol on hypoxia re‐oxygenation induced neuronal cell damage in vitro*

Huang

Zitta²,

Bein

et al. 2012

Anaesthesia

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SummaryPropofol may protect neuronal cells from hypoxia re-oxygenation injury, possibly via an antioxidant actions under hypoxic conditions. This study investigated the molecular effects of propofol on hypoxia-induced cell damage using a neuronal cell line. Cultured human IMR-32 cells were exposed to propofol (30 lM) and biochemical and molecular approaches were used to assess cellular effects. Propofol significantly reduced hypoxia-mediated increases in lactate dehydrogenase, a marker of cell damage (mean (SD) for normoxia: 0.39 (0.07) a.u.; hypoxia: 0.78 (0.21) a.u.; hypoxia + propofol: 0.44 (0.17) a.u.; normoxia vs hypoxia, p < 0.05; hypoxia vs hypoxia + propofol, p < 0.05), reactive oxygen species and hydrogen peroxide. Propofol also diminished the morphological signs of cell damage. Increased amounts of catalase, which degrades hydrogen peroxide, were detected under hypoxic conditions. Propofol decreased the amount of catalase produced, but increased its enzymatic activity. Propofol protects neuronal cells from hypoxia reoxygenation injury, possibly via a combined direct antioxidant effect along with induced cellular antioxidant mechanisms. Hypoxia and re-oxygenation events occur under various clinical conditions including intra-and peri-operative brain ischaemia [1][2][3][4][5]. In the brain, hypoxia re-oxygenation often leads to severe cellular damage resulting in a loss of neurological function and a poor clinical outcome [6][7][8]. The underlying mechanisms of hypoxia re-oxygenation injury are multifaceted, but recent studies point towards a central role of reactive oxygen species, which are generated during the hypoxia re-oxygenation [9] and may harm cells by damaging DNA, lipid peroxidation and oxidation of proteins [10].Propofol, a widely used intravenous anaesthetic, has been demonstrated to have neuroprotective properties in several in-vivo [11][12][13][14] and in-vitro [15][16][17] models of cerebral hypoxia re-oxygenation injury. Propofol contains a phenolic hydroxyl group and thus its structure resembles that of a-tocopherol (vitamin E) [18], a natural antioxidant. The antioxidant activity of propofol results partly from this phenolic chemical structure and may be responsible for its cytoprotective effects [19]. Moreover, propofol has been shown to induce and regulate intracellular signalling pathways [20,21] and the neuroprotective effects of propofol may also be mediated indirectly via the induction of cell-based antioxidant mechanisms.In the study presented, we employed an in-vitro model of human neuronal cells to mimic hypoxia reoxygenation events and evaluate the effects of anaesthetic

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mentioning

confidence: 99%

Effect of propofol on hypoxia re‐oxygenation induced neuronal cell damage in vitro*

Huang

Zitta²,

Bein

et al. 2012

Anaesthesia

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“…During intraoperative aneurysm surgery and ICU treatment probe placement in the territory of the aneurysm harboring vessel has been advocated [44,62,63]. As expected pbtO2 is lower in peri-contusional tissue than in normal appearing tissue on CT scanning in TBI patients [253].…”

Section: Catheter Placement and Sampling Sizementioning

confidence: 88%

“…monitoring technology is also used intraoperatively during aneurysm surgery [45,52,[60][61][62][63][64], during surgery of cerebral arterio-venous malformation [60,65,66], functional stereotaxy [67], and during cerebral angiography [68]. It has also been used in patients with spontaneous intraparenchymal hemorrhage [69][70][71][72][73][74][75][76], ischemic stroke in children and adults [36,71,77], severe haemorrhagic stroke [78], and in silent infarcts after subarachnoid hemorrhage [79].…”

Section: Pbto2mentioning

confidence: 99%

“…They report that: "Postoperative infarction in the territory of MCA developed in cases with an abrupt decrease of pbtO2 and a very low and persistent minimum value, during temporary clipping, and an incomplete recovery after definitive clipping. Verification of clip position should be considered when there is an incomplete recovery or a persistent fall in pbtO2 after definitive clipping" [62]. The same group has also published on the same matter for surgery of unruptured MCA aneurysms.…”

Section: Aneurysm Surgery -Intraoperative Utilitymentioning

confidence: 99%

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Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Lang

Jaeger²

2013

TOCCMJ

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This review has been compiled to assess publications related to the clinical application of direct cerebral tissue oxygenation (pbtO2) monitoring published in international, peer-reviewed scientific journals, or major meeting reports published as journal supplements. Its goal was to extract relevant, i.e. positive and negative, information on indications, clinical application, safety issues and impact on clinical situations, as well as treatment strategies in neurosurgery, neurosurgical anaesthesiology, neurosurgical intensive care, neurology, and related specialties. For completeness' sake it also presents related basic science research and case reports. This review is an update of its previous edition published elsewhere in 2007. This review reflects publications from 2004 to 2012. Only relevant publications prior to 2004, which explicitly addressed or systematically examined the above issues, are included in this review and are listed in the reference section. Based on 349 citations it is the most comprehensive review available on direct cerebral oxygen monitoring to this date.Keywords: Review, cerebral oxygenation, raumedic, licox, neurotrend, cerebral partial pressure of oxygen, brain tissue oxygenation. METHODSThis review is based on a systematic "Medline" literature search using the following search terms: licox, neurotrend, neurovent, raumedic, brain tissue oxygen, brain tissue oxygenation, cerebral oxygenation, cerebral tissue oxygen, cerebral partial pressure of oxygen, btO2, ptiO2, pti(O)2, ptiO(2), pbrO2, PBr(O2), P(bt)O(2), P(br)O(2), PbrO(2), BTpO2, tP(O2), PbO2, PbtO2, Pbto, PbtO(2).Only few publications were not retrieved using this technique. They were, however, identified through personal communication with scientists in the field, meeting proceedings and reviewer assignments. This strategy provided sufficient certainty that relevant papers have not been missed. Unpublished meeting abstracts and published conference proceedings were excluded for this review expect for few which provided comparative studies between different probes. To address relevant matters, related to specific pbtO2 issues, selected non-peer reviewed papers published in supplements were also used only when no other peer-reviewed information was available. RESULTSThis review is based on a previous review [1]. It is currently based on 349 papers, 274 more papers compared to its previous version in 2007, which warrants the update.

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“…At present, no method exists to predict the possibility of ischemia cased by aneurysm surgery. A study reported brain tissue oxygen concentration (PtiO(2)) was monitored during surgery of middle cerebral artery (MCA) aneurysm with SAH and found intraoperative monitoring of PtiO(2) may be a useful method of detection of changes in brain tissue oxygenation during MCA aneurysm surgery for detection of changes in brain oxygenation due to reduced blood flow, as a predictor of ischemic events [49] .…”

Section: Intraoperative Monitoring Methodsmentioning

confidence: 99%

Ruptured Cerebral Aneurysms: An Update

Ming¹,

Zhao²,

Li³

et al. 2012

Explicative Cases of Controversial Issues in Neurosurgery

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Monitoring of brain oxygenation in surgery of ruptured middle cerebral artery aneurysms

Cited by 17 publications

References 17 publications

Effect of propofol on hypoxia re‐oxygenation induced neuronal cell damage in vitro*

Effect of propofol on hypoxia re‐oxygenation induced neuronal cell damage in vitro*

Systematic and Comprehensive Literature Review of Publications on Direct Cerebral Oxygenation Monitoring

Ruptured Cerebral Aneurysms: An Update

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