Browsing by Subject "anesthesia"

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  • Leikas, Juuso V.; Kohtala, Samuel; Theilmann, Wiebke; Jalkanen, Aaro J.; Forsberg, Markus M.; Rantamaki, Tomi (2017)
    Parkinson's disease (PD) is a progressive neurodegenerative movement disorder primarily affecting the nigrostriatal dopaminergic system. The link between heightened activity of glycogen synthase kinase 3 beta (GSK313) and neurodegenerative processes has encouraged investigation into the potential disease-modifying effects of novel GSK3 beta inhibitors in experimental models of PD. Therefore, the intriguing ability of several anesthetics to readily inhibit GSK3 beta within the cortex and hippocampus led us to investigate the effects of brief isoflurane anesthesia on striatal GSK3 beta signaling in nave rats and in a rat model of early-stage PD. Deep but brief (20-min) isoflurane anesthesia exposure increased the phosphorylation of GSK3 beta at the inhibitory Ser9 residue, and induced phosphorylation of AKT(Thr308) (protein kinase B; negative regulator of GSK3 beta) in the striatum of naive rats and rats with unilateral striatal 6-hydroxydopamine (6-OHDA) lesion. The 6-OHDA protocol produced gradual functional deficiency within the nigrostriatal pathway, reflected as a preference for using the limb ipsilateral to the lesioned striatum at 2 weeks post 6-OHDA. Interestingly, such motor impairment was not observed in animals exposed to four consecutive isoflurane treatments (20-min anesthesia every 48 h; treatments started 7 days after 6-OHDA delivery). However, isoflurane had no effect on striatal or nigral tyrosine hydroxylase (a marker of dopaminergic neurons) protein levels. This brief report provides promising results regarding the therapeutic potential and neurobiological mechanisms of anesthetics in experimental models of PD and guides development of novel disease-modifying therapies.
  • Jokelainen, J.; Ismail, S.; Kylänpää, L.; Udd, M.; Mustonen, H.; Lindström, O.; Pöyhiä, R. (2020)
    Background and Aims: Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. Materials and Methods: A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. Results: Multivariate analysis showed post-endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p <0.001). Incidence of other adverse effects was too low for statistical analysis. Conclusion: Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient's individual needs.
  • Sun, Weilun; Suzuki, Kunimichi; Toptunov, Dmytro; Stoyanov, Stoyan; Yuzaki, Michisuke; Khiroug, Leonard; Dilyatev, Alexander (2019)
    Two-photon imaging of fluorescently labeled microglia in vivo provides a direct approach to measure motility of microglial processes as a readout of microglial function that is crucial in the context of neurodegenerative diseases, as well as to understand the neuroinflammatory response to implanted substrates and brain-computer interfaces. In this longitudinal study, we quantified surveilling and photodamage-directed microglial processes motility in both acute and chronic cranial window preparations and compared the motility under isoflurane and ketamine anesthesia to an awake condition in the same animal. The isoflurane anesthesia increased the length of surveilling microglial processes in both acute and chronic preparations, while ketamine increased the number of microglial branches in acute preparation only. In chronic (but not acute) preparation, the extension of microglial processes toward the laser-ablated microglial cell was faster under isoflurane (but not ketamine) anesthesia than in awake mice, indicating distinct effects of anesthetics and of preparation type. These data reveal potentiating effects of isoflurane on microglial response to damage, and provide a framework for comparison and optimal selection of experimental conditions for quantitative analysis of microglial function using two-photon microscopy in vivo.
  • Kesävuori, Risto; Vento, Antti; Lundbom, Nina; Schramko, Alexey; Jokinen, Janne J.; Raivio, Peter (2019)
    Introduction: A minimal volume ventilation method for robotically assisted mitral valve surgery is described in this study. In an attempt to reduce postoperative pulmonary dysfunction, 40 of 174 patients undergoing robotically assisted mitral valve surgery were ventilated with a small tidal volume during cardiopulmonary bypass. Methods: After propensity score matching, 31 patients with minimal volume ventilation were compared with 54 patients with no ventilation. Total ventilation time, PaO2/FiO(2) ratio, arterial lactate concentration, and the rate of unilateral pulmonary edema in the matched minimal ventilation and standard treatment groups were evaluated. Results: Patients in the minimal ventilation group had shorter ventilation times, 12.0 (interquartile range: 9.9-15.0) versus 14.0 (interquartile range: 12.0-16.3) hours (p = 0.036), and lower postoperative arterial lactate levels, 0.99 (interquartile range: 0.81-1.39) versus 1.28 (interquartile range: 0.99-1.86) mmol/L (p = 0.01), in comparison to patients in the standard treatment group. There was no difference in postoperative PaO2/FiO(2) ratio levels or in the rate of unilateral pulmonary edema between the groups. Conclusion: Minimal ventilation appeared beneficial in terms of total ventilation time and blood lactatemia, while there was no improvement in arterial blood gas measurements or in the rate of unilateral pulmonary edema. The lower postoperative arterial lactate levels may suggest improved lung perfusion among patients in the minimal volume ventilation group. The differences in the ventilation times were in fact small, and further studies are required to confirm the possible advantages of the minimal volume ventilation method in robotically assisted cardiac surgery.
  • Vuopio, Heidi (Helsingin yliopisto, 2018)
    Tiivistelmä - Referat - Abstract Tutkimuksen tavoitteena oli selvittää, mitkä anestesiologisen hoidon peri- sekä intraoperatiiviset tekijät vaikuttavat keuhkokomplikaatioiden esiintyvyyteen ruokatorven adenokarsinoomaa sairastavilla potilailla, joille on tehty mini-invasiivinen ruokatorviresektio. Tutkimukseen otettiin mukaan kaikki Helsingin Yliopistollisessa Keskusairaalassa vuosina 2015-2017 mini-invasiivisella leikkaustekniikalla leikatut ruokatorviresektio-potilaat, joiden diagnoosina oli ruokatorven adenokarsinooma. Potilaiden preoperatiivisia sekä perioperatiivisia muuttujia kerättiin retrospektiivisesti potilastietojärjestelmistä ja tarkasteltiin muuttujien suhdetta keuhkokomplikaatioihin. Tutkimuksessa havaittiin keuhkokomplikaatioita saaneiden potilaiden preoperatiivisessa keuhkofunktion (FEV1%) olevan merkittävästi heikompi verrattuna heihin, joilla komplikaatioita ei todettu (91% (IQR 23.5) vs. 76% (IQR 11), p 0.011). Lisäksi keuhkokomplikaatioita saaneet saivat toimenpiteen aikana enemmän noradrenaliinia (4.44mg (IQR 2.86) vs. 2.66mg (IQR 1.85), p 0.037). Lisäksi nestehoidossa havaittiin, että keuhkokomplikaatioita saaneilla käytettiin enemmän suonensisäistä albumiinia (36g (IQR 36) vs. 0g (IQR 32), p 0.032) sekä punasoluja (0 ml (IQR 188) vs. 0ml (IQR 0), p 0.047). Keuhkokomplikaatioita saaneilla oli hengityskonesäädöissä tilastollisesti merkittäviä eroja PEEP:n (positiivien loppuekspiratorinen paine) (7 cmH2O (IQR 2) vs. 6 cmH2O (IQR 2), p 0.02). Keuhkokomplikaatioita saaneet viettivät myös pidemmän ajan niin teho-osastolla kuin vuodeosastolla (13 vrk (IQR 4) vs. 24 vrk (IQR 19), p 0.002). Tutkimuksen perusteella leikkauksen yhteydessä käytettyillä vasoaktiiveilla sekä nestehoidolla näyttäisi mahdollisesti olevan yhteys keuhkokomplikaatioiden esiintyvyyteen. Tutkimuksessa havaittiin assosiaatio suuren noradrenaliinimäärän käytön sekä keuhkokomplikaatioiden välillä. Nämä löydökset perustuvat retrospektiiviseen aineistoon ja prospektiivista, tavoite-ohjattua tutkimusta intraoperatiivisen nestehoidon sekä vasoaktiivien käytön optimaalisesta suhteesta tarvitaan lisää.