Relative Higher Hematocrit Attenuates the Cerebral Excitatory Amino Acid Elevation Induced by Deep Hypothermic Circulatory Arrest in Rats

Zhu, Min; Zhao, Yanhua; Zheng, Yue; Su, Diansan; Wang, Xiangrui

doi:10.1089/ther.2013.0004

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…As a result, glycogen decomposition and gluconeogenesis are enhanced. This results in a weakened ability to absorb and utilize GLU, which leads to an increase in GLU[ 20 ]. In this study, 2 h after surgery, the increase in GLU was significantly lower in the remimazolam group than in the propofol group ( P < 0.05), verifying that intraoperative anesthesia induced by remimazolam benzenesulfonate maintained GLU stability during the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

Tang¹,

Yi²,

Gong³

et al. 2021

WJCC

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BACKGROUND Sedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation. AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia. METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison. RESULTS At pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups ( P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group ( P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05). CONCLUSION Compared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions...

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Section: Discussionmentioning

confidence: 99%

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

Tang¹,

Yi²,

Gong³

et al. 2021

WJCC

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“…[ 27 ] Cerebral damage induced by oxidative stress during DHCA attracts lots of attention, and excitatory amino acids were observed to increase significantly after DHCA. [ 28 ] Glutamate excitotoxicity was observed to be related to neuronal apoptosis and necrosis after hypothermic circulatory arrest. [ 29 ] In our study, several excitatory amino acids relating to oxidative stress were decreased in the DA group, including glutamine, glutamic acid, and aspartate, in which glutamine is the main precursor for excitatory neuromediator glutamate and inhibitory neurotransmitter γ-aminobutyric acid.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion

Zou

Liu

Zhang

et al. 2016

Chinese Medical Journal

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Background:Antegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.Methods:To clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without (DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.Results:Metabolic profiling of brain was distinctive significantly between the two groups (Q2Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.Conclusions:The present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

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“…However, the effects of N-ethylglycine on glycine transporter function may be disrupted by the physiological responses to cardiopulmonary bypass. In preclinical studies, intracerebral glycine concentrations were significantly elevated above baseline levels during (1) hypothermic circulatory arrest; (2) cardiopulmonary bypass reperfusion; and (3) glycine levels remained elevated for 2 to 8 h after hypothermic circulatory arrest [ 44 – 46 ]. Thus, in patients undergoing cardiac surgery, a key mechanism responsible for the analgesic effects of intravenous lidocaine infusions may be disrupted by the abrupt changes in glycine concentrations that occur in response to cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Lidocaine for postoperative pain after cardiac surgery: a systematic review

Boswell

Moman

Burtoft

et al. 2021

J Cardiothorac Surg

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Objective Lidocaine is one of the most widely used local anesthetics with well-known pharmacological properties. The purpose of this systematic review is to investigate the effects of lidocaine on postoperative pain scores and recovery after cardiac surgery. Methods A comprehensive database search was conducted by a reference librarian for randomized clinical trials (RCT) from January 1, 1980 to September 1, 2019. Eligible study designs included randomized controlled trials of lidocaine for postoperative pain management in adults undergoing cardiac surgery. After removal of duplicates, 947 records were screened for eligibility and 3 RCTs met inclusion criteria. Results Sources of bias were identified in 2 of 3 RCTs. Lidocaine was administered intravenously, topically, and intrapleurally. Key findings included [1] 2% lidocaine placed topically on chest tube prior to intraoperative insertion was associated with significantly lower pain scores and lower cumulative doses of fentanyl; and [2] 2% lidocaine administered intrapleurally was associated with significantly lower pain scores and significant improvements in pulmonary mechanics. Lidocaine infusions were not associated with significant changes in pain scores or measures of recovery. No significant associations were observed between lidocaine and overall mortality, hospital length of stay or ICU length of stay. No data were reported for postoperative nausea and vomiting or arrhythmias. Conclusions Due to the favorable risk profile of topical lidocaine and the need for further advancements in the postoperative care of adults after cardiac surgery, topically administered lidocaine could be considered for incorporation into established postoperative recovery protocols.

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Relative Higher Hematocrit Attenuates the Cerebral Excitatory Amino Acid Elevation Induced by Deep Hypothermic Circulatory Arrest in Rats

Cited by 5 publications

References 13 publications

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion

Lidocaine for postoperative pain after cardiac surgery: a systematic review

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