Changes in Plasma Orexin-A Levels in Sevoflurane-Remifentanil Anesthesia in Young and Elderly Patients Undergoing Elective Lumbar Surgery

Wang, Zhihua; Ni, Xinli; Li, Jiannan; Xiao, Zhaoyang; Wang, Chen; Zhang, Lina; Li, Tong; Dong, Hailong

doi:10.1213/ane.0000000000000109

Cited by 12 publications

(11 citation statements)

References 21 publications

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“…Orexin agonists and antagonists have the potential to alter the stability of the anaesthetised state and genetic ablation of orexinergic neurons, which causes acquired murine narcolepsy, delays emergence from anaesthesia without changing anaesthetic induction . In elderly patients this is more confusing, because a delay in awakening could be due to an orexinergic deficit, a decrease in the number of orexin receptors and the tuberomammillary nucleus and activating adrenergic centres’ response to this .…”

Section: Factors That Can Affect the Variability Of Neuronal Inertiamentioning

confidence: 99%

Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review

2019

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Summary Most anaesthetists using target‐controlled infusion systems will have observed that the calculated effect‐site concentration at loss of consciousness is usually higher than the concentration at emergence. Inertia is the ability of biological systems to keep a functional state at rest or in activity and is an active process of resistance to change in state. Hysteresis is a phenomenon whereby the value of a physical property lags behind changes in the effect that is causing it and this is also seen in anaesthesia pharmacology. Recently, a phenomenon called neuronal inertia has been proposed when trying to explain the resistance observed to changes in consciousness induced by general anaesthesia, independent of drug kinetics. This review discusses the existence of this phenomenon and the conceptual and practical impact it may have on induction and recovery from general anaesthesia.

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Section: Factors That Can Affect the Variability Of Neuronal Inertiamentioning

confidence: 99%

Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review

2019

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“…As general anaesthesia for surgery in the elderly population is commonly performed, 1 much attention has been given to the ageing-related postoperative cognitive disorders. Many elderly patients undergoing surgical procedures experience delayed emergence from anaesthesia, 2,3 and reduced metabolism and clearance of anaesthetics have been implicated. 3,4 Nevertheless, clinical research has revealed that, even when the ageadjusted minimum alveolar concentration (MAC) is applied, duration of anaesthesia is significantly longer in elderly patients than in middle-aged ones.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

“…Many elderly patients undergoing surgical procedures experience delayed emergence from anaesthesia, 2,3 and reduced metabolism and clearance of anaesthetics have been implicated. 3,4 Nevertheless, clinical research has revealed that, even when the ageadjusted minimum alveolar concentration (MAC) is applied, duration of anaesthesia is significantly longer in elderly patients than in middle-aged ones. 3 Orexin has a critical role in the sleepewake cycle 5e8 and in anaesthesia arousal regulation, 9e12 and we have found that plasma orexin concentrations in elderly patients are higher compared with adults, 3 consistent with previous observations in a healthy population.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

“…3,4 Nevertheless, clinical research has revealed that, even when the ageadjusted minimum alveolar concentration (MAC) is applied, duration of anaesthesia is significantly longer in elderly patients than in middle-aged ones. 3 Orexin has a critical role in the sleepewake cycle 5e8 and in anaesthesia arousal regulation, 9e12 and we have found that plasma orexin concentrations in elderly patients are higher compared with adults, 3 consistent with previous observations in a healthy population. 13 However, it remains unclear whether changes in the orexinergic system are associated with delayed emergence from anaesthesia in aged individuals.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

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Orexin-1 receptor is involved in ageing-related delayed emergence from general anaesthesia in rats

Ran

Wang

Yang

et al. 2018

British Journal of Anaesthesia

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Background: Previous clinical studies have shown that emergence from isoflurane anaesthesia takes longer in elderly patients compared with middle-aged patients. The current study investigated whether delayed emergence from anaesthesia in older age is associated with the age-related decrease in orexin receptors by using a rat model. Methods: Adult and aged SpragueeDawley rats were used to assess the time to emergence after 30 min isoflurane anaesthesia (1.4 vol%), and differences in the orexinergic systems, including the number of orexinergic neurones, plasma orexin concentrations, and expression of orexin-1 (OX1R) and orexin-2 receptors, compared using immunofluorescence, radioimmunoassay, western blot, and real-time polymerase chain reaction. The effects of OX1R expression on emergence time were determined by virus-mediated overexpression of OX1R using intra-cerebroventricular injection. Results: The median (range) emergence time of aged rats was longer than that in adult rats [1082 (1010e1130) compared with 848 (829e938) s; P¼0.0009]. Plasma orexin concentrations were higher in the aged group than the adult group [34 (33e37) and 25 (22e31) pg ml À1 , respectively; P¼0.04], but the number of orexinergic neurones was similar in both groups. Protein expression of OX1R was lower in the aged group compared with the adult group [0.47 (0.35e0.58) compared with 0.97 (0.86e1.32), respectively; P¼0.002]. Overexpression of OX1R significantly shortened the emergence time in aged rats from [1120 (1040e1190) s] to [769 (576e928) s; P¼0.03]. Conclusions: Age-related decrease in OX1R expression is associated with delayed emergence from isoflurane anaesthesia in aged rats.

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“…Although in vivo electrophysiologic recordings of activity are still needed, using c-Fos as a proxy for antecedent activity, neurons within many of these nuclei have been identified to be inhibited during general anesthesia [98,100,101,114]. Moreover, the causal reactivation of some wake-promoting neurons during emergence from the anesthetic state has been explored using approaches such as electrical stimulation, optogenetics, and chemogenetics [115][116][117][118] in rodents and suggested in humans [119]. It is important to note, however, that activation of wake-promoting neurons during emergence does not necessitate that inhibition of the same population occurred during induction of anesthesia, that potential inhibition was causal with respect to the induction of anesthesia, or that experimental reactivation recapitulates spontaneous changes in activity that occur during emergence.…”

Section: Reviewmentioning

confidence: 99%

The Biology of General Anesthesia from Paramecium to Primate

Kelz

Mashour

2019

Current Biology

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General anesthesia serves a critically important function in the clinical care of human patients. However, the anesthetized state has foundational implications for biology because anesthetic drugs are effective in organisms ranging from paramecia, to plants, to primates. Although unconsciousness is typically considered the cardinal feature of general anesthesia, this endpoint is only strictly applicable to a select subset of organisms that are susceptible to being anesthetized. We review the behavioral endpoints of general anesthetics across species and propose the isolation of an organism from its environment-both in terms of the afferent arm of sensation and the efferent arm of action-as a generalizable definition. We also consider the various targets and putative mechanisms of general anesthetics across biology and identify key substrates that are conserved, including cytoskeletal elements, ion channels, mitochondria, and functionally coupled electrical or neural activity. We conclude with a unifying framework related to network function and suggest that general anesthetics-from single cells to complex brains-create inefficiency and enhance modularity, leading to the dissociation of functions both within an organism and between the organism and its surroundings. Collectively, we demonstrate that general anesthesia is not restricted to the domain of modern medicine but has broad biological relevance with wide-ranging implications for a diverse array of species.

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Changes in Plasma Orexin-A Levels in Sevoflurane-Remifentanil Anesthesia in Young and Elderly Patients Undergoing Elective Lumbar Surgery

Abstract: Plasma orexin-A levels are not responsible for the delayed emergence from general anesthesia in elderly patients.

Cited by 12 publications

References 21 publications

Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review

Neural inertia and differences between loss of and recovery from consciousness during total intravenous anaesthesia: a narrative review

Orexin-1 receptor is involved in ageing-related delayed emergence from general anaesthesia in rats

The Biology of General Anesthesia from Paramecium to Primate

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