Relationship of asymmetric dimethylarginine to haemodialysis hypotension.

Hypotension is one of the major complications in patients undergoing haemodialysis (HD), that is well evident in patients defined as "hypotension-prone." The mechanisms underlying the hypotensive episodes are not known. We carried out a clinical study on hypotension-prone HD patients to test the existence of a dysregulation in the nitric oxide (NO) generating pathway. Since asymmetric dimethylarginine (ADMA) is an endogenous compound which regulates NO synthesis, we measured its variation in plasma of stable-HD and hypotension-prone patients before, during, and at the end of HD. Before HD, the hypotension-prone patients have higher ADMA levels than stable-HD patients. The HD procedure significantly removes ADMA from plasma of stable-HD patients, while in the hypotension-prone ADMA levels are unchanged at the end of the HD. Moreover, in the hypotension-prone patients, during the hypotensive episode, a dramatic drop of ADMA levels is observed, followed by a rapid increase at the end of the HD. The symmetric dimethylarginine (SDMA), which has no effect on NO synthesis, is also high in plasma of both groups of HD patients compared to normal subjects, and in both groups its levels at the end of HD are significantly reduced. The hypotension-prone patients have basal TNF-alpha levels lower than the stable-HD groups, that significantly increase during the hypotensive episode. On the basis of these findings, we suggest that the hypotensive syndrome could be related to a dysregulation between ADMA metabolism and clearance due both to cytokines release and to an extremely fast ADMA clearance during HD, leading to an increase in NO blood levels.     

Determination of the hydrophobicity of local anesthetic agents

Hydrophobicity, a term used to describe a fundamental physicochemical property of local anesthetics, was in the past obtained by octanol/buffer partitioning. It has been suggested that the octanol method, despite its obvious advantages, also has some drawbacks. HPLC has become an attractive alternative for the measurement of hydrophobicity and has been applied to local anesthetics recently. However, the methods in current use for measuring the hydrophobicity of local anesthetics suffer from a number of limitations and remain obscure. This study introduces a new HPLC method for measuring the hydrophobicity of eight local anesthetics in current clinical use. Using a C(18) derivatized polystyrene-divinylbenzene stationary phase HPLC column, the log k'(w) values of local anesthetics were determined by measuring the capacity factor k'(i) in the process of chromatographic separation using a hydrophobic stationary phase and a hydrophilic mobile phase. A rapid reversed-phase HPLC method was developed to directly measure log k'(w) of eight local anesthetics. A high correlation between log k'(w) and hydrophobicity (log P(oct)) from the traditional shake-flask method was obtained for the local anesthetics, demonstrating the reliability of the method. The results reveal an improved method for measuring the hydrophobicity of the local anesthetic agents in the unionized form. This simple, sensitive and reproducible approach may serve as a valuable tool for describing the physicochemical properties of novel local anesthetics.     

Exposure to common anesthetic agents alters pup-retrieval response in lactating rats.

This study investigated the lactating stage of rats to determine the effect on maternal behavior of a single exposure to general anesthetic. Lactating Wistar rats were treated with anesthetic doses of pentobarbital (PENT) or ketamine (KET) on day 3 or 9 of lactation, and their behavioral responses were evaluated during a 50-min nursing period, after a 4-h mother-pup separation, on day 12. Exposure to KET on day 9 led to a significantly longer latency to pup-retrieval than that of the control. Duration of pup-retrieval in mothers treated with KET on day 3 and 9 was significantly longer than in the control. Other components of maternal behavior did not differ between the groups. The present findings suggested that general anesthetics have an impact upon pup-retrieval activities, which indirectly represent maternal motivation.     

Operating-room venting of trace concentrations of inhalation anesthetic agents.

Operating-room personnel exposed over a long period to trace concentrations of anesthetic gases may acquire both organic disturbances and impairment of cerebral function, though this has not been proven. However, the dangers of miscalculations due to disturbances of cerebral function and the fact that all working personnel should be breathing unpolluted air are sufficient indications to make scavenging of anesthetic gases mandatory. Scavenging has been carried out in many hospitals. At Vancouver General Hospital venting of the gases has decreased the nitrous oxide pollution to what is considered an acceptable level.     

Effects of anesthetic agents on systemic critical O2 delivery

The present study tested the hypothesis that anesthetic agents can alter tissue O2 extraction capabilities in a dog model of progressive hemorrhage. After administration of pentobarbital sodium (25 mg/kg iv) and endotracheal intubation, the dogs were paralyzed with pancuronium bromide, ventilated with room air, and splenectomized. A total of 60 dogs were randomized in 10 groups of 6 dogs each. The first group served as control (C). A second group (P) received a continuous infusion of pentobarbital (4 mg.kg-2.h-2), which was started immediately after the bolus dose. Three groups received enflurane (E), halothane (HL), or isoflurane (I) at the end-tidal concentration of 0.7 minimum alveolar concentration (MAC). The sixth group received halothane at the end-tidal concentration of 1 MAC (HH). Two groups received intravenous alfentanil at relatively low dose (AL) or high dose (AH). The last two groups received intravenous ketamine at either relatively low dose (KL) or high dose (KH). In each group, O2 delivery (Do2) was progressively reduced by hemorrhage. At each step, systemic Do2 and O2 consumption (VO2) were measured separately and the critical point was determined from a plot of Vo2 vs. Do2. The critical O2 extraction ratio (OER) in the control group was 65.0 +/- 7.8%. OER was lower in all anesthetized groups (P, 44.3 +/- 11.8%; E, 47.0 +/- 7.7%; HL, 45.7 +/- 11.2%; I, 44.3 +/- 7.1%; HH, 33.7 +/- 6.0%; AL, 56.5 +/- 9.6%; AH, 43.5 +/- 5.9%; KH, 57.7 +/- 7.1%), except in the KL group (78.3 +/- 10.0%). The effects of halothane and alfentanil on critical OER were dose dependent (P less than 0.05), whereas critical OER was significantly lower in the KH than in the KL group. Moreover, the effects of anesthetic agents on critical Do2 appeared related to their effects on systemic vascular resistance. Anesthetic agents therefore alter O2 extraction by their peripheral vascular effects. However, ketamine, with its unique sympathetic stimulant properties, had a lesser effect on OER than the other anesthetic agents. It could therefore be the anesthetic agent of choice in clinical situations when O2 availability is reduced.     

Subcellular effects of some anesthetic agents on rat myocardium.

The effects of ether, chloroform, and halothane on calcium accumulation and ATPase activity of rat heart microsomes and mitochondria as well as on myofibrillar ATPase activity were investigated. Chloroform and halothane depressed microsomal and mitochondrial calcium uptake and binding in a parallel fashion. Ether decreased microsomal calcium binding and mitochondrial calcium uptake to varying degrees, while mitochondrial calcium binding was slightly enhanced. Whereas ether had no effect, chloroform depressed microsomal and mitochondrial total APTase activities and halothane decreased microsomsl ATPase and slightly stimulated mitochondrial total ATPase activities. Halothane was found to depress myofibrillar Mg2+-ATPase and ether was capable of decreasing myofibrillar Ca2+-ATPase. Chloroform was seen to inhibit both myofibrillar enzymes. These results suggest that the cardiodepressant actions of volatile anesthetic agents may be due to alterations in the calcium accumulating abilities of microsomal and mitochondrial membranes while direct myofibrillar effects may contribute to the depression seen with relatively higher concentrations of anesthetics.     

Selecting anesthetic agents for human safety and animal recovery surgery

This review provides information to scientists performing animal surgery with recommendations for choosing an appropriate anesthetic agent. The human health risks from exposure to various anesthetic agents as well as methods to minimize exposure are discussed. In brief, methoxyflurane, used with precautions, is recommended for rodent bench-top surgery. When a precision vaporizer is available, isoflurane is usually the agent of choice. Other agents, including injectables, are considered.     

Effects of some volatile anesthetic agents on rat heart sarcolemma.

The effects of ether, chloroform and halothane on rat heart sarcolemmal ATP hydrolyzing and calcium binding activities were studied. Sarcolemmal Na⁺ ? K⁺ ATPase activity was inhibited by halothane (1.8 – 18 mM) and stimulated by ether (7.1 – 42.6 mM) and chloroform (7.5 – 45 mM). Higher concentrations of ether (56.8 – 71 mM) and chloroform (60 – 75 mM) depressed the Na⁺ ? K⁺ ATPase activity. Chloroform (7.5 – 75 mM) and halothane (1.8 – 18 mM) were found to decrease Mg²⁺ ATPase and Ca²⁺ ATPase activities, whereas e0her (42.6 – 71 mM) depressed only the Mg²⁺ ATPase activity. Sarcolemmal calcium binding was depressed by ether (42.6 – 71 mM), chloroform (45 – 75 mM) and halothane (10.8 – 18 mM). These results suggest that the anesthetic - induced cardiac depression may partly be due to decreased sarcolemmal activities.     

Morphological alterations in cultured neuromuscular tissue induced by two anesthetic agents

A diversity of pathogenic effects was observed in two complementary culture systems following their exposure to the anesthetic agents. Thiopental sodium and ketamine hydrochloride. The cytotoxic effects of both agents in these two culture types were reversible and dose-related. In organotypic spinal cord slice cultures, thiopental sodium caused general toxicity but no demyelination, while ketamine hydrochloride induced, to a varied extent, damage of the myelin sheath and degeneration of mitochondria into multilamellar bodies. In autologous nerve-muscle co-cultures both anaesthetic agents caused the arrest of muscle contractions. However, when added to skeletal muscle cultures, the drugs differed in their effect. Thiopental sodium did not inhibit spontaneous muscle contractions indicating, as in the case of Tubocurarine, a direct effect of the drug on the neuromuscular junction. Ketamine hydrochloride, in contrast, arrested spontaneous muscle contractions, implying that it did not directly affect the neuromuscular synapse.Special is one dedicated to Dr. Paola S. Timiras.