Safety and Efficacy of Volatile Anesthetic Agents Compared With Standard Intravenous Midazolam/Propofol Sedation in Ventilated Critical Care Patients: A Meta-analysis and Systematic Review of Prospective Trials

Jerath, Angela; Panckhurst, Jonathan; Parotto, Matteo; Lightfoot, Nicholas J; Wąsowicz, Marcin; Ferguson, Niall D.; Steel, Andrew; Beattie, W. Scott

doi:10.1213/ane.0000000000001634

Cited by 105 publications

(69 citation statements)

References 42 publications

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“…Today, an increasing number of cancer patients receive surgery and general anesthesia is an unavoidable perioperative care for the surgical cancer population. In addition to induction and maintenance of general anesthesia, volatile anesthetic agents have been increasingly used for long‐term critical care sedation . The results of the present study and of those previous studies imply that the volatile anesthetic isoflurane has potential implications for the perioperative and intensive care of some overwhelmed and systemic inflammatory situations.…”

Section: Discussionsupporting

confidence: 57%

HDAC1 and HDAC2 regulate anti‐inflammatory effects of anesthetic isoflurane in human monocytes

et al. 2020

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Pre-exposure to volatile anesthetics inhibits inflammation induced by various stimuli, including surgical procedures and ischemia. We hypothesize that volatile anesthetics may induce anti-inflammatory effects via a mechanism involving regulation of histone deacetylases (HDACs). Pre-exposure of 1.5% isoflurane for 0.5 h induced anti-inflammatory effects [measured by cytokine production of tumor necrosis factor-ɑ, interleukin-8 (IL-8) and IL-1b] in both human THP-1 cells and primary human peripheral blood monocytes stimulated by lipopolysaccharide. In human THP-1 cells, coadministration of the HDAC inhibitor trichostatin A (TSA) blocked the isoflurane-induced antiinflammatory effects. TSA also blocked isoflurane-upregulated HDAC1-3 expression and isoflurane-reduced nuclear translocation of p65 and p50 subunits of nuclear factor-jB (NF-jB). The ability of isoflurane to reduce NF-jB nuclear translocation and proinflammatory responses in the cell line was blocked by gene silencing of HDAC1 and HDAC2, but not by gene silencing of HDAC3. A coimmunoprecipitation assay demonstrated that the decreased interaction between HDAC1 and HDAC2 through lipopolysaccharide was restored by isoflurane pretreatment. These findings were validated in primary human peripheral blood monocytes wherein gene silencing of HDAC1 and HDAC2 resulted in increased cytokine production and NF-jB nuclear translocation induced by isoflurane pre-exposure and lipopolysaccharide stimulation. These results indicate that anti-inflammatory effects of the volatile anesthetic isoflurane in human monocytes involve regulation of HDAC1 and HDAC2.

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Section: Discussionsupporting

confidence: 57%

HDAC1 and HDAC2 regulate anti‐inflammatory effects of anesthetic isoflurane in human monocytes

et al. 2020

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“…According to our results, it can be assumed that sex is not a determining factor that expresses the need for pharmacological sedation. The mean age in the studies of Jerath et al and Masuda et al were close, with the first one being 40, with a minimum age of 20 years and a maximum of 85, and the second study being 47 years, varying from 9 to 85 years old (14,19). When compared to the mean of our study (18 years), it can be observed that the means were higher; however, variations of ages were close to the present study, which presented ages from 6 to 78 years.…”

Section: Discussionmentioning

confidence: 74%

“…In this study, we used nasal or venous drugs to control anxiety in dentistry (13)(14)(15). The objective was to describe the mechanism of action of the drugs used, not the clinical signs such as blood pressure, oxygen saturation and the type of procedure performed.…”

Section: Discussionmentioning

confidence: 99%

Contribution of benzodiazepines in dental care of patients with special needs

et al. 2019

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Background: Conscious sedation in dental treatment of patients with special needs (PNEs) has the purpose of controlling events such as anxiety and fear, as well as promoting muscle relaxation and mastery of uncoordinated movements. Benzodiazepines (BZDs) are among the most used drugs due to their anxiolytic, hypnotic and sedative properties. The objective of this investigation is to demonstrate a study on the contribution of conscious sedation with BZD in PNEs. Material and Methods: The study included 40 PNEs, non-collaborators, submitted to conscious oral sedation with Midazolam (0.5 mg/kg) for dental treatment, receiving vital signs monitoring in the pre, trans and postoperative periods. Results: Male patients were more frequent with 70% of the cases, with a mean age of 18 years. As for medical diagnosis, autism and mental deficiency were the most prevalent. The most performed procedures were restoration (32%) and exodontia (30%). There was a statistically significant reduction in systolic and diastolic blood pressure parameters (p<0.05) in the transoperative and postoperative periods when compared to the preoperative period. Conscious sedation with BZDs resulted in 83% positive responses. Conclusions: The results demonstrate that this technique is safe and effective, and can be used in outpatient care for PNEs. However, the risk/benefit ratio should be correctly evaluated.

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“…Because of these advantageous properties, sevo urane and other inhalational anesthetics are increasingly used as general sedatives for invasive diagnostic and therapeutic procedures, mechanical ventilation and management of agitation in intensive care unit. The concentration required for sedation is approximately one third (0.3 minimum alveolar concentration) of the concentration required for general anesthesia with less incidence of nausea and vomiting 14 . The present study aims to test our hypothesis that inhaling low concentration of sevo urane attenuates the abnormal behaviors and reverses the changes to GABA A R associated proteins in a mice model of MK801induced schizophrenia.…”

Section: Introductionmentioning

confidence: 99%

Low-concentration sevoflurane inhalation in treating MK801-induced schizophrenia like disease in mice and a feasibility study of schizophrenia patients

Zhao¹,

Shi²,

Ling³

et al. 2020

Preprint

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GABAergic deficits have been considered to associate with the pathophysiology of schizophrenia and hence GABA receptor subtype A (GABAARs) modulators may have therapeutic values for schizophrenia. Sevoflurane, a commonly used volatile anesthetic, enhances GABAergic neurotransmission through the GABAAR. The present study aims to investigate the therapeutic effectiveness of low-concentration sevoflurane in MK801-induced schizophrenia-like mice and amongst schizophrenia patients in a single arm trial. Three weeks after administration of MK801 (0.5 mg/kg, i.p. twice a day) for five days, mice were exposed to 1% sevoflurane for 1 hr/day for 5 days. One week after treatment, they were subjected to behavioral tests, and then sacrificed for immunohistochemical stain, western blot assay and electrophysiology recordings in the prefrontal cortex. Ten schizophrenia patients received 5-hr sevoflurane (0.5–1.2%) for 6 days, and were assessed with the PANSS and the BPRS-18 in the 1st and 2nd week after the treatments. MK801 induced hypolocomotion and social deficits, downregulated the expression of NMDARs subunits, and postsynaptic density protein 95 (PSD95), reduced parvalbumin- and GAD67-positive neurons, and changed the amplitude and frequency of mEPSC and mIPSC and evenly increased the excitation/inhibition (E/I) ratio. All these changes induced by MK-801 were attenuated by sevoflurane administration. Schizophrenia symptoms assessed with the scales were significantly improved in the 1st and 2nd week after treatments. Low-concentration sevoflurane inhalation effectively reversed MK801-induced schizophrenia-like disease in mice and alleviated schizophrenia patients’ symptoms. Our work suggested that sevoflurane may be a valuable therapeutic strategy for treating schizophrenia patients.

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Safety and Efficacy of Volatile Anesthetic Agents Compared With Standard Intravenous Midazolam/Propofol Sedation in Ventilated Critical Care Patients: A Meta-analysis and Systematic Review of Prospective Trials

Cited by 105 publications

References 42 publications

HDAC1 and HDAC2 regulate anti‐inflammatory effects of anesthetic isoflurane in human monocytes

HDAC1 and HDAC2 regulate anti‐inflammatory effects of anesthetic isoflurane in human monocytes

Contribution of benzodiazepines in dental care of patients with special needs

Low-concentration sevoflurane inhalation in treating MK801-induced schizophrenia like disease in mice and a feasibility study of schizophrenia patients

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