Propofol anesthesia impairs the maturation and survival of adult-born hippocampal neurons.

BACKGROUND: Adult neurogenesis occurs in the hippocampus of most mammals, including humans, and plays an important role in hippocampal-dependent learning. This process is highly regulated by neuronal activity and might therefore be vulnerable to anesthesia. In this article, the authors investigated this possibility by evaluating the impact of propofol anesthesia on mouse hippocampal neurons generated during adulthood, at two functionally distinct maturational stages of their development. METHODS: Adult-born hippocampal neurons were identified using the cell proliferation marker bromodeoxyuridine or a retroviral vector expressing the green fluorescent protein in dividing cells and their progenies. Eleven or 17 days after the labeling procedure, animals (n = 3-5 animals per group) underwent a 6-h-long propofol anesthesia. Twenty-one days after labeling, the authors analyzed the survival, differentiation, and morphologic maturation of adult-born neurons using confocal microscopy. RESULTS: Propofol impaired the survival and maturation of adult-born neurons in an age-dependent manner. Anesthesia induced a significant decrease in the survival of neurons that were 17 days old at the time of anesthesia, but not of neurons that were 11 days old. Similarly, propofol anesthesia significantly reduced the dendritic maturation of neurons generated 17 days before anesthesia, without interfering with the maturation of neurons generated 11 days before anesthesia. CONCLUSIONS: These results reveal that propofol impairs the survival and maturation of adult-born hippocampal neurons in a developmental stage-dependent manner in mice.

Satisfaction maternelle de la prise en charge anesthésique durant l'accouchement: une étude de cohorte rétrospective. [Risk factors associated with maternal satisfaction during childbirth: a retrospective cohort study.]

PURPOSE: Factors associated with maternal satisfaction of anesthetic management during labour and delivery are poorly known. The purpose of this study was to assess these factors. METHODS: We performed a retrospective cohort study on parturients admitted between January 2004 and December 2008. Data on patients' demographics, comorbidities, procedures performed and various aspects of their anesthetic experience were retrieved from the anesthetic records. Maternal satisfaction was measured using a numerical scale from 0 to 10 (0 = not satisfied at all, 10 = very satisfied). A cutoff of ≤ 6 was taken as poor satisfaction. We performed a multivariate analysis to identify the different predictors of maternal satisfaction and more specifically those related to pain, overall experience with the technique, delays, and presence of anesthetic, obstetrical and neonatal complications. RESULTS: There were 15,386 parturients admitted during the study period. Of these, 10,034 had complete information in the chart and 761 (7.6%) parturients were dissatisfied with their anesthetic care. Factors decreasing patient satisfaction were high risk pregnancy [odds ratio (OR) 95% confidence interval (CI) 0.59 (0.34-1.02)] and difficult delivery [OR (95% CI) 0.62 (0.52-0.74)]. Pain, a negative experience of the procedure, delays, poor coordination in management, and the presence of complications decreased patient satisfaction [OR (95% CI) 0.07 to 0.71]; P < 0.001. CONCLUSION: Maternal satisfaction with anesthesia care is largely determined by the effectiveness and correct performance of the procedure carried from the technical and human point of view. However, other factors such as a good coordination in patient management and the absence of complications also influence maternal satisfaction.

Deep thiopental anesthesia alters steady-state glucose homeostasis but not the neurochemical profile of rat cortex.

Barbiturates are regularly used as an anesthetic for animal experimentation and clinical procedures and are frequently provided with solubilizing compounds, such as ethanol and propylene glycol, which have been reported to affect brain function and, in the case of (1)H NMR experiments, originate undesired resonances in spectra affecting the quantification. As an alternative, thiopental can be administrated without any solubilizing agents. The aim of the study was to investigate the effect of deep thiopental anesthesia on the neurochemical profile consisting of 19 metabolites and on glucose transport kinetics in vivo in rat cortex compared with alpha-chloralose using localized (1)H NMR spectroscopy. Thiopental was devoid of effects on the neurochemical profile, except for the elevated glucose at a given plasma glucose level resulting from thiopental-induced depression of glucose consumption at isoelectrical condition. Over the entire range of plasma glucose levels, steady-state glucose concentrations were increased on average by 48% +/- 8%, implying that an effect of deep thiopental anesthesia on the transport rate relative to cerebral glucose consumption ratio was increased by 47% +/- 8% compared with light alpha-chloralose-anesthetized rats. We conclude that the thiopental-induced isoelectrical condition in rat cortex significantly affected glucose contents by depressing brain metabolism, which remained substantial at isoelectricity.

Syndrome d'apnées du sommeil: un risque pour l'anesthésie générale [Obstructive sleep apnea: a risk for general anesthesia?]

There are many case reports of serious complications and death among obstructive sleep apnea patients (OSA) during general anesthesia or postoperative analgesia. Sedatives and anesthetic agents, pharyngeal anatomy of these patients, opiates given for analgesia, and post operative REM sleep rebound represent potential hazards for general anesthesia in OSA patients. Ideally these patients should be treated with continuous positive airway pressure (CPAP) during premedication, directly after extubation and during postoperative analgesia. Unfortunately, only about 20% of these patients are diagnosed before surgery. A special attention should be given to the symptoms and signs suggestive of OSA during preoperative visits. Screening tests should be performed in patients with suspected OSA and, if positive, a treatment should be initiated.

Incidents occuring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.

L'induction rapide du sevrage par des antagonistes des opiacés sous anesthésie: une alternative dans le traitement de la dépendance aux opiacés [Rapid induction of withdrawal with opiate antagonists under anesthesia: an alternative to treatment of opiate dependence?]

Rapid induction of withdrawal by opiate antagonists under anesthesia is an opiate detoxification technique. This technique is useful to reduce intensity and duration of withdrawal. Therefore, this technique represents an alternative strategy in the treatment of opiate addicted patients. This paper attempts to present a brief history of this technique, and a critical review of related issues.

Incidents occurring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.

Le sevrage ultra-rapide sous anesthésie générale: l'expérience de l'Hôpital de St-Loup [Ultrafast opiate detoxification under general anesthesia: the St. Loup Hospital experience]

Rapid antagonist induction under anesthesia is a method that has been increasingly used to detoxify opiate addicts. These procedures are useful to reduce the duration and the discomfort of withdrawal. However, the high risk and the cost of these methods require randomized clinical trial to evaluate safety and clinical effectiveness. The University Substance Abuse Division of Lausanne and the Intensive Care Unit of the St-Loup Hospital work on a randomized clinical trial comparing anesthesia-assisted versus traditional clonidine detoxification combined with an additional psychosocial week. This paper describes the technique of anesthesia used in our study. Our clinical experience suggests that, integrating this technique in a multidisciplinary network, with a strong emphasis on post-anesthetic follow-up, is a viable and safe option in the treatment of opiate dependence.

Ulnar nerve transposition at the elbow : local anesthesia should be preferred to general anesthesia

Après la compression du nerf médian au niveau du tunnel carpien, la compression du nerf ulnaire au niveau du coude est le deuxième syndrome compressif le plus fréquent des nerfs périphériques. La chirurgie des nerfs périphériques consiste dans une décompression nerveuse et est caractérisée par un suivi post¬opératoire parfois très douloureux avec des douleurs qui peuvent chroniciser si insuffisamment traitées. Le traitement chirurgical de décompression nerveuse se fait traditionnellement sous anesthésie générale ou régionale. Une analgésie post-opératoire plus efficace et durable avec moindre risque de chronicisation avait justifié ce choix jusqu'à ce jour. Grâce au développement de la chirurgie ambulatoire ces dernières années, un grand nombre d'interventions chirurgicales au niveau de la main sont effectués sous anesthésie locale. Au vu d'une meilleure connaissance de cette technique d'anesthésie, son rôle dans la chirurgie des nerfs périphériques a été remis en question. Alors que plusieurs études ont démontré que l'anesthésie locale est aussi efficace que l'anesthésie générale et régionale au sujet de la chirurgie du tunnel carpien, son utilisation pour la chirurgie du nerf ulnaire reste peu connue. La raison de l'hésitation à l'utilisation de l'anesthésie locale pour le traitement du tunnel ulnaire est due au fait que dans plus de la moitié des cas, une simple décompression n'est pas suffisante et qu'il est souvent nécessaire de transposer le nerf ulnaire devant l'épicondyle ulnaire. La seule publication disponible au sujet de l'utilisation de l'anesthésie locale dans le traitement du tunnel ulnaire considère comme irréalisable d'utiliser cette méthode dans le cas d'une transposition. Malgré cette mise en garde, nous avons, depuis plusieurs années, des excellents résultats avec la transposition du nerf ulnaire sous anesthésie locale. Avec le but d'objectiver notre expérience dans ce domaine nous avons souhaité analyser nos résultats de façon rétrospective avec particulière attention aux douleurs post-opératoires et à la satisfaction des patients. Les dossiers de cinquante patients Consécutifs (26F, 24M) opérés par le même chirurgien dans notre service de 2002 à 2012 ont été analysés rétrospectivement. Les critères suivants ont été récoltés: l'âge du patient, la profession, la main dominante, les détails des techniques opératoires utilisées, le type d'anesthésie, l'intensité du suivi ainsi que les complications, le niveau de douleur dans l'immédiat post-opératorie ainsi que à une année de l'intervention. Les patients ont été divisés en 4 groupes: les opérés sous anesthésie générale avec transposition du nerf (n=17) ou sans transposition (n=10) et les opérés sous anesthésie locale avec transposition (n=12) ou sans transposition (n=11). Au premier jour la douleur était comparable dans tous les groupes. A une semaine, elle était deux fois plus importante lorsque la transposition avait été réalisée sous anesthésie générale par rapport à si une anesthésie locale avait été effectuée (p=0.03). La satisfaction s'est révélée plus élevée mais non significative chez les patients opérés sous anesthésie locale. Ces derniers étaient significativement plus enclins à répéter la chirurgie comparé a ceux opérés sous anesthésie générale (p=0.04). En conclusion, les résultats de cette étude suggèrent que l'anesthésie locale est au moins autant efficace que l'anesthésie générale en termes de complications et de douleurs post-opératoires indépendamment du fait qu'une transposition nerveuse soit effectuée ou pas. Un meilleur contrôle des douleurs à une semaine post-opératoire a contribué à une haute satisfaction des patients de notre étude.

Anesthesia prevents auditory perceptual learning.

BACKGROUND: An auditory perceptual learning paradigm was used to investigate whether implicit memories are formed during general anesthesia. METHODS: Eighty-seven patients who had an American Society of Anesthesiologists physical status of I-III and were scheduled to undergo an elective surgery with general anesthesia were randomly assigned to one of two groups. One group received auditory stimulation during surgery, whereas the other did not. The auditory stimulation consisted of pure tones presented via headphones. The Bispectral Index level was maintained between 40 and 50 during surgery. To assess learning, patients performed an auditory frequency discrimination task after surgery, and comparisons were made between the groups. General anesthesia was induced with thiopental and maintained with a mixture of fentanyl and sevoflurane. RESULTS: There was no difference in the amount of learning between the two groups (mean +/- SD improvement: stimulated patients 9.2 +/- 11.3 Hz, controls 9.4 +/- 14.1 Hz). There was also no difference in initial thresholds (mean +/- SD initial thresholds: stimulated patients 31.1 +/- 33.4 Hz, controls 28.4 +/- 34.2 Hz). These results suggest that perceptual learning was not induced during anesthesia. No correlation between the bispectral index and the initial level of performance was found (Pearson r = -0.09, P = 0.59). CONCLUSION: Perceptual learning was not induced by repetitive auditory stimulation during anesthesia. This result may indicate that perceptual learning requires top-down processing, which is suppressed by the anesthetic.

Ulnar Nerve Transposition at the Elbow under Local Anesthesia: A Patient Satisfaction Study.

Background Ulnar nerve decompression at the elbow traditionally requires regional or general anesthesia. We wished to assess the feasibility of performing ulnar nerve decompression and transposition at the elbow under local anesthesia. Methods We examined retrospectively the charts of 50 consecutive patients having undergone ulnar nerve entrapment surgery either under general or local anesthesia. Patients were asked to estimate pain on postoperative days 1 and 7 and satisfaction was assessed at 1 year. Results On day 1, pain was comparable among all groups. On day 7, pain scores were twice as high when transposition was performed under general anesthesia when compared with local anesthesia. Patient satisfaction was slightly increased in the local anesthesia group. These patients were significantly more willing to repeat the surgery. Conclusion Ulnar nerve decompression and transposition at the elbow can be performed under local anesthesia without added morbidity when compared with general anesthesia.