Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Roth, D.; Petersen-Felix, Steen; Bak, Peter; Arendt‐Nielsen, Lars; Fischer, Michael J.M.; Bjerring, Peter; Zbinden, A. M.

doi:10.1093/bja/76.1.38

Cited by 23 publications

(13 citation statements)

References 22 publications

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“…5 Extensive studies designed to assess the analgesic effect of subanesthetic concentrations of isoflurane in human volunteers using a wide variety of experimental pain models failed to demonstrate a clear analgesic effect. 43,44 However, hyperalgesia was also not observed.…”

Section: Pain Medicinementioning

confidence: 95%

Pungent General Anesthetics Activate Transient Receptor Potential-A1 to Produce Hyperalgesia and Neurogenic Bronchoconstriction

Eilers

Cattaruzza²,

Nassini

et al. 2010

Anesthesiology

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Section: Pain Medicinementioning

confidence: 95%

Pungent General Anesthetics Activate Transient Receptor Potential-A1 to Produce Hyperalgesia and Neurogenic Bronchoconstriction

Eilers

Cattaruzza²,

Nassini

et al. 2010

Anesthesiology

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“…A number of studies show that the amplitudes of specific peaks of the cortical evoked potential waveform are attenuated following administration of analgesic interventions (35)(36)(37)(38). In these situations, measures of evoked potentials show the same effects observed with verbal reports.…”

Section: Cortical Evoked Potentialsmentioning

confidence: 95%

Pain measurement

Gracely

1999

Acta Anaesthesiol Scand

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Increasing evidence from laboratory methods in humans and animals indicates that pain arises from, and is modulated by, a number of mechanisms. In addition, these mechanisms are not static but change as pain persists. Recent human studies have demonstrated new aspects of pain processing at all levels of the central nervous system. Studies of the influence of analgesic agents on a large number of experimental pain measures have shown a preferential effect of opioids for attenuating the central integration of prolonged stimuli while local anesthetics may be more effective for brief stimulation. Studies of NK1 antagonists in man have shown results similar to those found with animals. There is little effect on brief stimulation of A delta and C-fiber nociceptors, including conditions that can evoke central summation. However, these antagonists, which block the effects of substance P, are effective in more persistent states such as postsurgical pain. Persistent pain can also alter the function of the large diameter A beta touch afferents, ranging from increased tactile sensitivity in inflammatory conditions to frank allodynia following nerve injury or focal nociceptor stimulation. Recent advances in evaluation of supraspinal pain processing in humans have demonstrated pain-related activation using both methods that assess synchronized neural activity and methods that infer this activity in the whole brain by local changes in regional cerebral blood flow. These methods have begun to identify brain regions associated with the multiple dimensions and processing of painful stimulation and the modulation of these processes by pharmacological agents and non-pharmacological interventions.

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“…Specific nociceptive potentials are also evoked by single, clinically required skin breaking procedures in the human infant brain 13,14 and have been used in this age group to measure the postnatal development of cortical pain processing 10 . In adult humans and rodents, nociceptive evoked potential amplitudes decrease with increasing concentrations of isoflurane 9,15 but, to date, the sensitivity of nociceptive potentials to anesthesia in infants has not been studied. In a study of the whisker barrel cortex of neonatal rats, sensory potentials evoked by whisker deflection persisted at surgical isoflurane levels (1.5-2%) that completely suppressed the EEG and silenced 4 spontaneous neuronal firing 16 .…”

Section: Introductionmentioning

confidence: 99%

Differential Suppression of Spontaneous and Noxious-evoked Somatosensory Cortical Activity by Isoflurane in the Neonatal Rat

2016

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Background: The effect of neonatal anesthesia and pain on the developing brain is of considerable clinical importance but few studies have evaluated noxious surgical input to the infant brain under anesthesia. Here we tested the effect of increasing isoflurane concentration upon spontaneous and evoked nociceptive activity in the somatosensory cortex of rats at different postnatal ages. Methods: Intracortical extracellular field potentials evoked by hindpaw C-fiber electrical stimulation were recorded in the rat somatosensory cortex at postnatal day (P)7, 14, 21 and 30 during isoflurane anesthesia (n=7 per group). The amplitudes of evoked potentials and the energies of evoked oscillations (1-100Hz over 3 sec) were measured following equilibration at 1.5% isoflurane and during step increases in inspired isoflurane. Responses during and after plantar hindpaw incision were compared at P7 and P30 (n=6 per group). Results: At P7, cortical activity was silent at isoflurane 1.5% but noxious evoked potentials decreased only gradually in amplitude and energy with step increases in isoflurane. The resistance of noxious evoked potentials to isoflurane at P7 was significantly enhanced following surgical hindpaw incision (69±16% vs 6±1% in non-incised animals at maximum inspired isoflurane). This resistance was age dependent; at P14-30, noxious evoked responses decreased sharply with increasing isoflurane (step 3 (4%) P7: 50±9%, P30: 4±1% of baseline). Hindpaw incision at P30 sensitized noxious evoked potentials, but this was suppressed by higher isoflurane concentrations. Conclusions: Despite suppression of spontaneous activity, cortical evoked potentials are more resistant to isoflurane in young rats and are further sensitized by surgical injury.

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Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Cited by 23 publications

References 22 publications

Pungent General Anesthetics Activate Transient Receptor Potential-A1 to Produce Hyperalgesia and Neurogenic Bronchoconstriction

Pungent General Anesthetics Activate Transient Receptor Potential-A1 to Produce Hyperalgesia and Neurogenic Bronchoconstriction

Pain measurement

Differential Suppression of Spontaneous and Noxious-evoked Somatosensory Cortical Activity by Isoflurane in the Neonatal Rat

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