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Anesthesia and the Patient with Epilepsy
Published in Stanley R. Resor, Henn Kutt, The Medical Treatment of Epilepsy, 2020
Samantha L. Mullis, A. Donald Finek
Enflurane (1,1,2-trifluro-2-chloroethyl difluromethyl ether) is a halogenated ether inhalational anesthetic agent which is notable for its limited biotransformation, rapid induction and emergence, and ability to produce excellent direct muscle relaxation (5). It is unique among the halogenated agents in that it can precipitate epileptiform activity that is sometimes accompanied by motor activity in both laboratory animals, and in patients who have not received a muscle relaxant intraoperatively in the setting of high normal range inspired enflurane concentrations and/or hypocarbia (6,7). This epileptiform activity is manifested by diffuse high-amplitude spikes and/or spike wave complexes at times associated with synchronous twitching of the muscles of the face and tongue (8,9). It can be terminated without difficulty either by decreasing the inspired concentration of enflurane and/or by reducing minute ventilation and thereby increasing C02. However, neither barbiturates nor diazepam (DZP) administered during steady-state enflurane anesthesia are likely to abolish it (10). In fact DZP and ketamine as well may actually exacerbate an already established enflurane-induced seizure pattern. In addition, tricyclic antidepressants, DZP, and alfathesin are known to lower the seizure threshold under enflurane anesthesia and will result in the appearance of motor activity at concentrations far less than those required to produce the same activity in patients not given those medications (11–14).
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
At a dose of 1.5–3.0%, enflurane is typically used for maintenance of anesthesia. It induced a state of surgical anesthesia within 10 min when inhaled at a dose of 4% with oxygen (Brunton et al., 2011; Golan, 2012).
A Potential Role for Immunological Mechanisms in Halothane Hepatotoxicity
Published in Robert G. Meeks, Steadman D. Harrison, Richard J. Bull, Hepatotoxicology, 2020
Andrea K. Hubbard, Timothy P. Roth, A. Jay Gandolfi
Although anesthetic-induced hepatotoxicity may be initiated by direct or metabolite-mediate process following halothane exposure, this liver injury may also be the result of an immune-mediated process. However, the association between halothane-induced liver injury and an immune response directed toward a metabolite-altered hepatocyte protein has been under scrutiny for several years with ambiguous results. The following review will present evidence thus far published on the influence by the immune system in initiating or exacerbating this disease entity as substantiated by epidemiologic data, by humoral and cell-mediated mechanisms of injury, by the presence of halothane-induced antigens, by the relevance of immune complex levels in patients and by the association of HLA genotype in halothane patients to disease outcome. Finally, results will be described which suggest an immunologic cross-sensitization between halothane and enflurane, and the possible impact on current anesthesia.
Investigation of health risk assessment sevoflurane on indoor air quality in the operation room in Ahvaz city, Iran
Published in Toxin Reviews, 2019
Abdolkazem Neisi, Masoumeh Albooghobeish, Sahar Geravandi, Hamid Reza Adeli Behrooz, Mohammad Mahboubi, Yusef Omidi Khaniabad, Aliasghar Valipour, Azimeh Karimyan, Mohammad Javad Mohammadi, Majid Farhadi, Ahmad Reza Yari, Ali Ghomeishi
Sevoflurane have health effects for acute exposure. Several study demonstrate the concerning effects of inhalation of volatile AGs especially sevoflurane on human health (Hoerauf et al.1999, Mierdl et al.2003, Summer et al.2003, Gupta et al.2016). Based on report IARC states there are inadequate evidence about various aspects especially the carcinogenicity of sevoflurane, enflurane, halothane and isoflurane in both animals and humans (Kanmura et al.2000, Lachenmeier et al.2009, Kumar and Tripathi 2015). According different study, memory problems, headaches, fatigue, dizziness, impaired fertility, carcinogenesis, decreased immunity, liver and kidney damage are the most important health effects of sevoflurane (Saurel-Cubizolles et al.1992, McGregor 2000, Accorsi et al.2001, Burm 2003, Hasei et al.2003, Michel and Constantin 2009, Tankó et al.2009, Sárkány et al.2016). According result the studied teratogenic, anesthesia gases especially sevoflurane can increase the rate of morbidity on HCWs in ORs (Guirguis et al.1990, McGregor 2000). The blood-gas partition coefficient of sevoflurane is 0.69; molecular weight (200.1); rate of metabolism (3–5%); odor (acceptable); airway irritation (0); recovery (rapid); cost (high) are the most physical properties sevoflurane (Yasuda et al.1991, Michel and Constantin 2009, Devisscher et al.2010, Chatrath et al.2016, Freiermuth et al.2016, Walsh 2016).
Intracerebroventricular infusion of D-serine decreases nociceptive behaviors induced by electrical stimulation of the dura mater of rat
Published in Neurological Research, 2019
xiaolin Wang, zhe Yu, zi He, qiang Zhang, shengyuan Yu
Because the electrodes were fixed on the exposed parietal bone, intracerebroventricular administration was conducted using a 1.0-mL microsyringe with a glass micropipette (tip outer diameter, 20 ± 10 μm). The rats were lightly anesthetized with enflurane (Baxter Caribe, Guayama, Puerto Rico), a very short-acting inhalational anesthetic, and placed into a stereotactic frame. The glass micropipette was inserted into the cerebroventricle through the cranial window, as described above. D-serine (S4250; Sigma-Aldrich, Shanghai, China) was infused at a speed of 1 μL (1 mol/μL)/2 min for 20 min, and the glass micropipette was left in place for 2 min before removal. Saline was administered intracerebroventricularly via the same route. After the intacerebroventricular administration, rats were put into the cage for 1 h to observe their condition. Any rat showing unwell physical state had been excluded from the further electrical stimulation.
Comparisons of acute inflammatory responses of nose-only inhalation and intratracheal instillation of ammonia in rats
Published in Inhalation Toxicology, 2019
Linda Elfsmark, Lina Ågren, Christine Akfur, Elisabeth Wigenstam, Ulrika Bergström, Sofia Jonasson
A sub-lethal concentration was decided on the basis of a small-scale pilot study where different concentrations were tested from 0.25% to 2.5% NH3 via i.t. instillation and the lung injury was evaluated at 24 h post-exposure. A final concentration of 1% NH3 (25% weight percent NH3, Merck Eurolab AB, Sweden) diluted in water, with a pH 11.75 at room temperature (approximately ≥90% un-ionized NH3 in the solution (Emerson et al. 1975)), was chosen for the study. The rats were anesthetized briefly using enflurane before NH3 was administered by i.t. instillation in a volume of 200 μl. Control rats, given only the solvent, did not show any response different from unexposed healthy rats. In the full-scale rat study, the concentration of 1% NH3 was used and its effects were evaluated at 5 h, 24 h, 14 days, or 28 days post-exposure. Data regarding body weight, cells in BALF, inflammatory cytokines, organ weights, respiratory mechanics, collagen deposition, and histopathology are shown for all animals.