Delayed recovery from anesthesia: A postgraduate educational review

Misal, Ullhas Sudhakarrao; Joshi, Sneha; Shaikh, Mudassir Mohd

doi:10.4103/0259-1162.165506

Cited by 116 publications

(103 citation statements)

References 50 publications

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“…Delayed recovery of behavioral responsiveness in Drosophila may therefore be a promising model for studying cognitive impairments following general anesthesia in humans, which also often follow a longer time course than simply regaining consciousness. 40 A full restoration of presynaptic functions across the brain is probably a complex problem in any animal, and the extremely conserved nature of synaptic release mechanisms suggests this might be a common mechanism.…”

Section: Discussionmentioning

confidence: 99%

Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster

et al. 2019

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Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Mutations in the presynaptic protein syntaxin1A modulate general anesthetic effects in vitro and in vivo. Coexpression of a truncated syntaxin1A protein confers resistance to volatile and intravenous anesthetics, suggesting a target mechanism distinct from postsynaptic inhibitory receptor processes. Hypothesizing that recovery from anesthesia may involve a presynaptic component, the authors tested whether syntaxin1A mutations facilitated recovery from isoflurane anesthesia in Drosophila melanogaster. Methods A truncated syntaxin1A construct was expressed in Drosophila neurons. The authors compared effects on isoflurane induction versus recovery in syntaxin1A mutant animals by probing behavioral responses to mechanical stimuli. The authors also measured synaptic responses from the larval neuromuscular junction using sharp intracellular recordings, and performed Western blots to determine whether the truncated syntaxin1A is associated with presynaptic core complexes. Results Drosophila expressing a truncated syntaxin1A (syx227, n = 40) were resistant to isoflurane induction for a behavioral responsiveness endpoint (ED50 0.30 ± 0.01% isoflurane, P < 0.001) compared with control (0.240 ± 0.002% isoflurane, n = 40). Recovery from isoflurane anesthesia was also faster, with syx227-expressing flies showing greater levels of responsiveness earlier in recovery (reaction proportion 0.66 ± 0.48, P < 0.001, n = 68) than controls (0.22 ± 0.42, n = 68 and 0.33 ± 0.48, n = 66). Measuring excitatory junction potentials of larvae coexpressing the truncated syntaxin1A protein showed a greater recovery of synaptic function, compared with controls (17.39 ± 3.19 mV and 10.29 ± 4.88 mV, P = 0.014, n = 8 for both). The resistance-promoting truncated syntaxin1A was not associated with presynaptic core complexes, in the presence or absence of isoflurane anesthesia. Conclusions The same neomorphic syntaxin1A mutation that confers isoflurane resistance in cell culture and nematodes also produces isoflurane resistance in Drosophila. Resistance in Drosophila is, however, most evident at the level of recovery from anesthesia, suggesting that the syntaxin1A target affects anesthesia maintenance and recovery processes rather than induction. The absence of truncated syntaxin1A from the presynaptic complex suggests that the resistance-promoting effect of this molecule occurs before core complex formation.

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Section: Discussionmentioning

confidence: 99%

Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster

et al. 2019

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“…Delayed recovery from anaesthesia was multifactorial and anaesthetic agents may not be absolutely the offender. This included patient factors like genetic variation, body habitus and cognitive status or metabolic factors like hypothermia and hypothyroidism or surgical/anaesthetic factors like duration of surgery and combined regional anaesthesia with anaesthetic drugs which was of possible correlation with our results; presence of pain may enhance arousal whereas somnolence may be maintained with regional anaesthetic techniques [50].…”

Section: Case Nomentioning

confidence: 94%

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Siam

Aliaa

El-Medany

et al. 2020

Egyptian Journal of Anaesthesia

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Background: Perioperative pain management should be planned preoperatively and based on usage of pharmacological and non-pharmacological modalities as a multimodal analgesia (MMA). Regional anaesthesia has superior advantages than opioid-based anaesthesia and is one of the cornerstones of the Enhanced Recovery After Surgery (ERAS) especially in Patients undergoing spine surgery having already troublesome chronic pain and analgesic use. The present study was carried out to compare erector spinae plane block (ESP) with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery. Materials and Methods: This study was done on thirty adult patients of both sexes scheduled for elective lumbar spine surgery under general anaesthesia. They were randomly categorized into two equal groups (fifteen patients each); ESP was used for group I, and MMA was used for group II. Data was collected on anaesthetic requirements based on entropy monitoring and haemodynamic parameters, stress response measurement based on serum cortisol and blood glucose levels, controlled hypotensive anaesthesia; various drugs required and doses given, intraoperative and postoperative analgesia, postanaesthesia care unit data concerning recovery. Results: The group I (ESP) had statistically significant decrease of the response and the response-state entropy difference levels when compared to the group II (MMA) after stimulus and during the 1st time interval. The incidence of hemodynamic changes was significantly higher in the group I (ESP) than group II (MMA). Only the serum cortisol but not the blood glucose levels had statistically significant lower mean values 4 h postoperatively in group I (ESP) compared to group II (MMA). The patients received ESP had statistically significant lower mean expired isoflurane concentration, decreased emergence time, intraoperative fentanyl consumption and total dose of pethidine given up to 8 hrpostoperatively. Conclusions: Erector spinae plane block (ESP) can be considered safe and effective perioperative analgesic modality for lumbar spine simple decompression surgery. It helps in controlled hypotensive anaesthetic technique and decreases inhalational anaesthetics and intraoperative opioid requirements.

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“…Current research indicates that both the central nervous and autonomic systems are related to the depth of anaesthesia (DoA) of a patient [2]. Excessively deep or shallow DoA can result in harmful complications for patients; a DoA that is too shallow increases the risk of intraoperative awareness [3], and a DoA that is too deep can cause delayed recovery [4], cognitive dysfunction, and even death [5]. Therefore, accurate DoA monitoring is crucial to reduce the complications associated with overdose or insufficiency of anaesthetics and guarantee the safety and quality of anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Heart Rate Variability-Derived Features Based on Deep Neural Networks for Monitoring Depth of Anaesthesia

Zhan

Duan

et al. 2020

Preprint

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Background: Estimating the depth of anaesthesia (DoA) is critical in clinical anaesthesiology. Electroencephalograms (EEGs) have been widely used for monitoring the DoA; however, they may be inaccurate under certain conditions. Methods: In this study, we propose a novel method to evaluate the DoA based on multiple heart rate variability (HRV)-derived features combined with a discrete wavelet transform and deep neural networks (DNNs). Four features were extracted from an electrocardiogram, including the HRV high-frequency power, low-frequency power, high-to-low-frequency power ratio, and sample entropy. Next, these features were used as inputs for the DNN, which used the expert assessment of consciousness level as the reference output. Finally, the DNN was compared with the logistic regression (LR), support vector machine (SVM), and decision tree (DT) models. The data of 23 anaesthesia patients were used to assess the proposed method. Results: The results demonstrated that the accuracies of the four models, in distinguishing the anaesthesia states, were 86.2% (LR),87.5% (SVM),87.2% (DT), and 90.1%(DNN). Our method outperformed the LR, SVM, and DT methods.Conclusions: The proposed method could accurately distinguish between different anaesthesia states, thus, providing an alternative or supplementary method to EEG monitoring for the assessment of DoA.

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Delayed recovery from anesthesia: A postgraduate educational review

Cited by 116 publications

References 50 publications

Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster

Syntaxin1A Neomorphic Mutations Promote Rapid Recovery from Isoflurane Anesthesia in Drosophila melanogaster

Erector spinae plane block combined with general anaesthesia versus conventional general anaesthesia in lumbar spine surgery

Heart Rate Variability-Derived Features Based on Deep Neural Networks for Monitoring Depth of Anaesthesia

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