Sergey Pisklakov

Propofol Exposure in Pregnant Rats Induces Neurotoxicity and Persistent Learning Deficit in the Offspring

Propofol is a general anesthetic widely used in surgical procedures, including those in pregnant women. Preclinical studies suggest that propofol may cause neuronal injury to the offspring of primates if it is administered during pregnancy. However, it is unknown whether those neuronal changes would lead to long-term behavioral deficits in the offspring. In this study, propofol (0.4 mg/kg/min, IV, 2 h), saline, or intralipid solution was administered to pregnant rats on gestational day 18. We detected increased levels of cleaved caspase-3 in fetal brain at 6 h after propofol exposure. The neuronal density of the hippocampus of offspring was reduced significantly on postnatal day 10 (P10) and P28. Synaptophysin levels were also significantly reduced on P28. Furthermore, exploratory and learning behaviors of offspring rats (started at P28) were assessed in open-field trial and eight-arm radial maze. The offspring from propofol-treated dams showed significantly less exploratory activity in the open-field test and less spatial learning in the eight-arm radial maze. Thus, this study suggested that propofol exposure during pregnancy in rat increased cleaved caspsase-3 levels in fetal brain, deletion of neurons, reduced synaptophysin levels in the hippocampal region, and persistent learning deficits in the offspring.

Statins as Potentially Neuroprotective Agents: A Review

The aim of this literature review is to assess the experimental and clinical evidence regarding potential neuroprotective effects of statins and their possible perioperative benefit. Statins are drugs used to control cholesterol disorders and prevent cardiovascular diseases by four mechanisms: improvement of endothelial function, modulation of inflammatory responses, maintenance of plaque stability, and prevention of thrombus formation. It is possible that these various effects may also be neuroprotective. The anti-inflammatory effects of statins on endothelial cell mechanisms are better understood than their role in neuroprotection or tumoral apoptosis and evidence is only just emerging that statins may be beneficial. Data regarding perioperative use of statins in neurosurgery is scarce, controversial and inconclusive since there is a lack of convincing randomized, prospective clinical trials. More trials in humans are needed to determine whether statins could contribute to the current management of neurosurgical diseases. Not much is known about utilizing statins as a prophylactic treatment and some would probably advocate that we should be treating ‘at risk’ patients with statins perioperatively or at least it is important to try to put this into a clinical perspective.

Acute Hyperkalemia and Hyponatremia Following Intraoperative Mannitol Administration

Intravenous mannitol may lead to electrolyte disturbances involving sodium and potassium and resulting in cardiac dysfunction. This report demonstrates that when mannitol is given during intracranial surgery it can cause large increase potassium ion concentration and decrease in sodium ion concentration in the absence of any other possible causes. Intraoperative checks of serum electrolyte levels, arterial blood gas analysis and electrocardiogram monitoring could be recommended to be done routinely when using mannitol.

Corneal abrasion and visual evoked potentials monitoring: causes and prevention.

Aims: The objective of this review is to explore the methods of eye protection from corneal abrasions during general anesthesia as they relate to procedures utilizing visual evoked potentials (VEP) monitoring. Because these protective measures may lower the accuracy of the VEP equipment, we wish to establish through existing literature current effective eye protection (with a focus on TegadermTM) and why they could potentially interfere with VEP recording.

Unusual airway situation: esophageal stethoscope knotted around endotracheal tube

Abstract The following is an account of a rare airway management situation not previously described in the literature: an esophageal stethoscope knotted around the endotracheal portion of an endotracheal tube with difficulty removing

Anesthesia-Induced Rhabdomyolysis During Corrective Spine Surgery: A Case Report

We present a case in which a pediatric cerebral palsy patient developed int raoperative myoglobinuria and rhabdomyolysis with elevated creatine kinase (CK) during prone scoliosis surgery. A diagnosis of rhabdomyolysis was established with the finding of tea colored urine intraoperatively, and confirmed with elevated urine myoglobi n and CK postoperatively. Cerebral palsy patients may develop anesthesia -induced rhabdomyolysis when inhalational anesthetics used.

Duchenne muscular dystrophy: Management of difficult airway and concurrent bronchospasm

Using succinylcholine and inhalation agents for patients with Duchenne muscular dystrophy is extremely risky. Those risks include heart failure, cardiac dysrhythmias, rhabdomyolysis and malignant hyperthermia. Even in emergent situations, such as intraoperative bronchospasm, succinylcholine and inhalational agents are often considered contraindicated. Nevertheless, if intraoperative bronchospasm does occur in a patient with Duchenne muscular dystrophy, the benefits of using inhalational agents to treat bronchospasm may outweigh the risks in certain situations.

A Case of Mitochondrial Myopathy with Cardiac Involvement: Management in the Same Day Surgery Setting

Leighs disease, also known as Subacute Necrotizing Encephalomyelopathy, is an inherited myopathy causing degradation of motor skills with occasional cardiac involvement. Anesthesia experience for this disease has been rarely reported. Anesthetic can be safely preformed on a patient with Leighs disease in ambulatory setting. Extreme caution is required if the patient presents with cardiomyopathy manifestations of the syndrome.