Occurrence of Adenylate Kinase in Cerebrospinal Fluid after Isoflurane Anaesthesia and Orthognathic Surgery

Abstract

The study objective was, firstly, to investigate whether anaesthesia with induced arterial hypotension would cause leakage of a biochemical marker of neuronal injury, adenylate kinase (AK), into the cerebrospinal fluid (CSF). (Definition: arterial hypotension = mean arterial pressure (MAP) 50-65 mmHg during 2 10 rnin). Secondly, a subgroup of patients was examined with a limited battery of psychometric tests.Patients, scheduled for orthognathic surgery, were allocated to either hypotension (n=20) or normotension (n=20). Seventeen patients were subjected to psychometry. Increases in CSF-AK activities may be a non-specific occurrence in the perioperative interval, possibly indicating an adverse effect on the brain. Arterial hypotension could not be proven to explain the CSF-AK outcome. 7-96024491

Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia

“…We used isoflurane as the hypnotic component of general anaesthesia in our previous clinical practice and in the cited study in which the first observation of a blood pressure drop from lidocaine infiltration was made (1). The reason for changing to propofol was that it has come to be our routine hypnotic agent due to its excellent recovery characteristics.…”

“…A re‐calibration procedure was done 5–10 min before the injection of each study drug. Changes in MAP during the first 5 min after infiltration were analysed (1). The lowest level during a minimum of 2 min in this period of interest was registered, as was the change in heart rate.…”

“…I N OUR CLINICAL practice we have regularly noticed hypotensive episodes in close relation to submucosal infiltration of 5.4 mL lidocaine, 20 mg · mL −1 , with adrenaline, 12.5 μg · mL −1 , in patients undergoing orthognathic surgery during general anaesthesia (1). The blood pressure decrease is mild, transient, and clinically insignificant for some patients, while others have to be given phenylephrine to keep MAP >50 mmHg.…”

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

“…A possible explanation for the observed phenomenon could be an indication that minimal, yet detectable, neuronal cell debris is released into systemic blood as a result of regional cerebral desaturation, which was in turn detectable by NIRS. Along that line, it has previously been reported that cerebrospinal fluid (CSF) transaminases (SGOT, ALAT) were elevated in hypotensive anaesthesia (≤50 mmHg) 23,24 . In non‐human studies, Maas 25 reported that CSF enzymes were elevated in acute brain injury in rats.…”

Isoflurane Inhibits the Na+/K+-ATPase: Reply

“…However, in a subsequent study, in which patients were randomly assigned to hypo-or normotension, we could not confirm the hypothesis. 10 At this stage, we speculated on the role of ion pumps. A PhD student worked hard for several months trying to set up a mouse model to investigate this aspect, but he unfortunately failed.…”