Anesthetics fragment hippocampal network activity,alter spine dynamics,and affect memory consolidation

General anesthesia is characterized by reversible loss of consciousness accompanied by transient amnesia. Yet, long-term memory impairment is an undesirable side effect. How different types of general anesthetics (GAs) affect the hippocampus, a brain region central to memory formation and consolidation, is poorly understood. Using extracellular recordings, chronic 2-photon imaging, and behavioral analysis, we monitor the effects of isoflurane (Iso), medetomidine/midazolam/fentanyl (MMF), and ketamine/xylazine (Keta/Xyl) on network activity and structural spine dynamics in the hippocampal CA1 area of adult mice. GAs robustly reduced spiking activity, decorrelated cellular ensembles, albeit with distinct activity signatures, and altered spine dynamics. CA1 network activity under all 3 anesthetics was different to natural sleep. Iso anesthesia most closely resembled unperturbed activity during wakefulness and sleep, and network alterations recovered more readily than with Keta/Xyl and MMF. Correspondingly, memory consolidation was impaired after exposure to Keta/Xyl and MMF, but not Iso. Thus, different anesthetics distinctly alter hippocampal network dynamics, synaptic connectivity, and memory consolidation, with implications for GA strategy appraisal in animal research and clinical settings.

Amnesia is a central part of the 200 million general anesthesia that are administered worldwide every year, but it is unclear how it affects the hippocampus. This mouse study explores how three commonly used anesthetics influence cellular network activity, spine dynamics and memory consolidation, finding that each of the three anesthetics alters the local field potential, spiking activity and cellular calcium dynamics in a unique way, and they all impact long-term spine dynamics.     

Effects of Sevoflurane on Young Male Adult C57BL/6 Mice Spatial Cognition

Inhalation anesthetics are reported to affect cognition in both animals and humans. The influence of inhalation anesthetics in learning and memory are contradictory. We therefore investigated the effects of sevoflurane anesthesia with different durations on cognitive performance and the levels of NMDA receptor subunit NR2B, phosphorylated ERK1/2 (p-ERK1/2) and activated caspase3 in mouse hippocampus. We anaesthetized eight-week old male C57BL/6 mice with 2.5% sevoflurane for durations ranging from one to four hours. Non-anaesthetized mice served as controls. Mice exposed to sevoflurane for one to three hours showed improved performance, whereas mice with exposure up to four hours displayed similar behavioral performance as control group. NR2B was increased both at 24h and at two weeks post sevoflurane exposure in all groups. The p-ERK1/2: total ERK1/2 ratio increased at 24h in all anesthesia groups. The ratio remained elevated at two weeks in groups with two- to four-hour exposure. Activated caspase3 was detected elevated at 24h in groups with two- to four-hour exposure. The elevated trend of activated caspase3 was still detectable at two weeks in groups with three- to four-hour exposure. At two weeks post anesthesia, the typical morphology associated with apoptotic cells was observed in the hippocampus of mice exposed to four hours of sevoflurane. Our results indicate that 2.5% sevoflurane exposure for one to three hours improved spatial cognitive performance in young adult mice. The cognitive improvement might be related to the increase of NR2B, the p-ERK1/2: total ERK1/2 ratio in hippocampus. However, exposure to sevoflurane for four hours caused neurotoxicity due to caspase3 activation and apoptosis.     

The comparative influence of anesthetics on the in vitro proton NMR relaxation times in rat liver

To determine the effect of anesthetics on liver relaxation times in rat, two experiments were performed. In the first experiment, normal and protein-depleted rats underwent total hepatectomy under ether anesthesia or following decapitation. In the second experiment, livers were excised from normal rats under ketamine or pentobarbital anesthesia, or following decapitation. Hepatic T1 and T2 were measured for all animals using a RADX 10 MHz spin analyzer. Ketamine produced T1 values significantly different from decapitation. Ketamine, pentobarbital, and ether in normal animals all produced T2 values significantly different from decapitation. It is apparent that anesthetization of rats prior to in vitro measurement of hepatic relaxation times is not equivalent to decapitation; nor are the anesthetics examined equivalent to one another.     

Volatile Anesthetics Influence Blood-Brain Barrier Integrity by Modulation of Tight Junction Protein Expression in Traumatic Brain Injury

Disruption of the blood-brain barrier (BBB) results in cerebral edema formation, which is a major cause for high mortality after traumatic brain injury (TBI). As anesthetic care is mandatory in patients suffering from severe TBI it may be important to elucidate the effect of different anesthetics on cerebral edema formation. Tight junction proteins (TJ) such as zonula occludens-1 (ZO-1) and claudin-5 (cl5) play a central role for BBB stability. First, the influence of the volatile anesthetics sevoflurane and isoflurane on in-vitro BBB integrity was investigated by quantification of the electrical resistance (TEER) in murine brain endothelial monolayers and neurovascular co-cultures of the BBB. Secondly brain edema and TJ expression of ZO-1 and cl5 were measured in-vivo after exposure towards volatile anesthetics in native mice and after controlled cortical impact (CCI). In in-vitro endothelial monocultures, both anesthetics significantly reduced TEER within 24 hours after exposure. In BBB co-cultures mimicking the neurovascular unit (NVU) volatile anesthetics had no impact on TEER. In healthy mice, anesthesia did not influence brain water content and TJ expression, while 24 hours after CCI brain water content increased significantly stronger with isoflurane compared to sevoflurane. In line with the brain edema data, ZO-1 expression was significantly higher in sevoflurane compared to isoflurane exposed CCI animals. Immunohistochemical analyses revealed disruption of ZO-1 at the cerebrovascular level, while cl5 was less affected in the pericontusional area. The study demonstrates that anesthetics influence brain edema formation after experimental TBI. This effect may be attributed to modulation of BBB permeability by differential TJ protein expression. Therefore, selection of anesthetics may influence the barrier function and introduce a strong bias in experimental research on pathophysiology of BBB dysfunction. Future research is required to investigate adverse or beneficial effects of volatile anesthetics on patients at risk for cerebral edema.     

Azaperone and azaperone-ketamine as a neuroleptic sedative and anesthetic in rats and mice

Azaperone alone and combined with ketamine were evaluated as sedative and anesthetic agents in outbred rats and mice. Using azaperone alone the duration of immobility was 1.9 to 10.8 hours for mice and 0.9 to 2.4 hours for rats. The withdrawal reflex was not eliminated from mice receiving azaperone alone; however, the withdrawal reflex was eliminated from 0.9 to 2.4 hours in rats receiving azaperone. Azaperone produced a tachypnea in rats and male mice while a depressed respiratory rate was observed in female mice. Using azaperone combined with ketamine, the duration of immobilization was 1.1 to 8.8 hours for mice and 1.3 to 6.0 hours for rats. The duration loss of the withdrawal reflex, which was used as an indication of surgical anesthesia, was 0.9 to 1.8 hours for mice and 1.0 to 6.0 hours for rats. An increase in respiratory rate was observed in rats given the combination while mice given the combination showed transient tachypnea followed by bradypnea. Overall, azaperone alone was shown to provide sedation in mice as compared to a dose dependent anesthesia in rats. The azaperone-ketamine combination produced a surgical plane of anesthesia in both rats and mice. Azaperone and the azaperone-ketamine combination appear to be a suitable alternative to sedatives and anesthetics currently used in rats and mice.     

Xenon pretreatment may prevent early memory decline after isoflurane anesthesia and surgery in mice

Postoperative cognitive decline (POCD) is a common complication following surgery, but its aetiology remains unclear. We hypothesized that xenon pretreatment prevents POCD by suppressing the systemic inflammatory response or through an associated protective signaling pathway involving heat shock protein 72 (Hsp72) and PI3-kinase. Twenty-four hours after establishing long-term memory using fear conditioning training, C57BL/6 adult male mice (n = 12/group) received one of the following treatments: 1) no treatment group (control); 2) 1.8% isoflurane anesthesia; 3) 70% xenon anesthesia; 4) 1.8% isoflurane anesthesia with surgery of the right hind leg tibia that was pinned and fractured; or 5) pretreatment with 70% xenon for 20 minutes followed immediately by 1.8% isoflurane anesthesia with the surgery described above. Assessments of hippocampal-dependent memory were performed on days 1 and 7 after treatment. Hsp72 and PI3-kinase in hippocampus, and plasma IL-1β, were measured using western blotting and ELISA respectively, from different cohorts on day 1 after surgery. Isoflurane induced memory deficit after surgery was attenuated by xenon pretreatment. Xenon pretreatment prevented the memory deficit typically seen on day 1 (P = 0.04) but not on day 7 (P = 0.69) after surgery under isoflurane anesthesia, when compared with animals that underwent surgery without pretreatment. Xenon pretreatment modulated the expression of Hsp72 (P = 0.054) but had no significant effect on PI3-kinase (P = 0.54), when compared to control. Xenon pretreatment also reduced the plasma level increase of IL-1β induced by surgery (P = 0.028). Our data indicated that surgery and/or Isoflurane induced memory deficit was attenuated by xenon pretreatment. This was associated with a reduction in the plasma level of IL-1β and an upregulation of Hsp72 in the hippocampus.     

小型猪体外循环下心脏手术的麻醉

目的研究医学手术实验用小型猪体外循环下心脏手术的麻醉管理及麻醉效果。方法实验用小型猪34例,分为CPB下停跳组手术组（停跳组,18例）及CPB下并行手术组（并行组,16例）,行自体心包片三尖瓣置换术。记录实验中麻醉药物及血管活性药用量,基础麻醉、麻醉维持及麻醉苏醒时间,术后3天、一周存活状况等,并评价基础麻醉及全麻效果。结果 34例均在全麻下顺利完成手术,各期血流动力学平稳,仅停跳组一例术后3天内死亡,存活率97.1%,麻醉效果良好。结论合理的麻醉药物与血管活性药物的联合应用,仔细的临床观察与正确而迅速的处理是小型猪体外循环下心脏手术麻醉的关键。     

General Anesthetics Effects on Circadian Temporal Structure: An Update

Disruptions of circadian and biological rhythms as well as general anesthesia can induce sleep disorders, resulting in an increase in sleepiness and drowsiness and a decrease in vigilance. It has been previously shown that circadian time can influence the pharmacologic sensitivity and the duration of action of general anesthetics. Studies on interactions between general anesthesia and circadian rhythms are few, but all of them suggest an important role of general anesthetics on circadian rhythms. General anesthesia is a particular wake‐sleep state that could potentially alter circadian rhythms on the days following anesthesia. The aim of this review is to discuss the various effects of general anesthesia on animal and human circadian time structure. This topic is highly relevant to clinicians, especially those involved in that field of ambulatory practice responsible for post‐operative patient care, including patient recovery and fatigue.     

Lactate levels in the brain are elevated upon exposure to volatile anesthetics: a microdialysis study

Anesthetic agents have well-defined pharmacological targets but their effects on energy metabolism in the brain are poorly understood. In this study, we examined the effects of different anesthetics on extracellular lactate and glucose levels in blood, CSF and brain of the mouse. In vivo-microdialysis was used to monitor extracellular energy metabolites in the brain of awake mice and during anesthesia with seven different anesthetic drugs. In separate groups, lactate and glucose concentrations in blood and CSF were measured for each anesthetic. We found that anesthesia with isoflurane caused a large increase of extracellular lactate levels in mouse striatum and hippocampus (300-400%). Pyruvate levels also increased while glucose and glutamate levels were unchanged. This effect was dose-dependent and was mimicked by other gaseous anesthetics such as halothane and sevoflurane but not by intravenous anesthetics. Ketamine/xylazine and chloral hydrate caused 2-fold increases of glucose levels in mouse blood and brain while lactate levels were only moderately increased. Propofol caused a minor increase of extracellular glucose levels while pentobarbital had no effect on either lactate or glucose. Volatile anesthetics also increased lactate levels in blood and CSF by 2-3-fold but had no effect on plasma glucose. Further experiments demonstrated that lactate formation by isoflurane in mouse brain was independent of neuronal impulse flow and did not involve ATP-dependent potassium channels. We conclude that volatile anesthetics, but not intravenous anesthetics, cause a specific, dose-dependent increase in extracellular lactate levels in mouse brain. This effect occurs in the absence of ischemia, is independent of peripheral actions and is reflected in strongly increased CSF lactate levels.     

Lactate levels in the brain are elevated upon exposure to volatile anesthetics: A microdialysis study

Anesthetic agents have well-defined pharmacological targets but their effects on energy metabolism in the brain are poorly understood. In this study, we examined the effects of different anesthetics on extracellular lactate and glucose levels in blood, CSF and brain of the mouse. In vivo-microdialysis was used to monitor extracellular energy metabolites in the brain of awake mice and during anesthesia with seven different anesthetic drugs. In separate groups, lactate and glucose concentrations in blood and CSF were measured for each anesthetic. We found that anesthesia with isoflurane caused a large increase of extracellular lactate levels in mouse striatum and hippocampus (300–400%). Pyruvate levels also increased while glucose and glutamate levels were unchanged. This effect was dose-dependent and was mimicked by other gaseous anesthetics such as halothane and sevoflurane but not by intravenous anesthetics. Ketamine/xylazine and chloral hydrate caused 2-fold increases of glucose levels in mouse blood and brain while lactate levels were only moderately increased. Propofol caused a minor increase of extracellular glucose levels while pentobarbital had no effect on either lactate or glucose. Volatile anesthetics also increased lactate levels in blood and CSF by 2–3-fold but had no effect on plasma glucose. Further experiments demonstrated that lactate formation by isoflurane in mouse brain was independent of neuronal impulse flow and did not involve ATP-dependent potassium channels. We conclude that volatile anesthetics, but not intravenous anesthetics, cause a specific, dose-dependent increase in extracellular lactate levels in mouse brain. This effect occurs in the absence of ischemia, is independent of peripheral actions and is reflected in strongly increased CSF lactate levels.     

A comparison of pentobarbital, fentanyl-droperidol, ketamine-xylazine and ketamine-diazepam anesthesia in adult male rats

Proper use of anesthetics is of paramount importance for humane animal care. Current research trends show a greater reliance on rats for laboratory investigations. This study compared several dosages for four different drugs, (pentobarbital, fentanyl-droperidol, ketamine-xylazine and ketamine-diazepam) for use in the laboratory rat. Each drug was evaluated in respect to its onset, duration of effect, recovery, adverse effects and mortality. A quantitative assessment of the depth of anesthesia also was obtained for all dosages of each drug. Results showed that all tested dosages of pentobarbital, ketamine-xylazine and ketamine-diazepam were suitable anesthetics for use in the laboratory rat. Low dosages of fentanyl-droperidol (Innovar-Vet), however, appeared to produce a state known as neuroleptanalgesia as opposed to anesthesia seen with the other agents.     

不同麻醉方法对大鼠血气电解质及能量代谢的影响

目的探讨不同麻醉方法和不同麻醉药物对大鼠血气、电解质及能量代谢的影响。方法采用异氟烷、乙醚吸入麻醉,戊巴比妥钠、水合氯醛腹腔注射麻醉,经腹主静脉取血,经血气一电解质分析仪全自动分析测定,观察不同麻醉方法和麻醉药物对大鼠血气、电解质及能量代谢的影响。结果异氟烷吸人麻醉组Na’离子浓度略低于戊巴比妥钠腹腔注射组（P〈0．05）;戊巴比妥钠腹腔注射组Ca2离子浓度显著低于其他三组（P〈0．01）;吸入麻醉组的Mg2离子浓度显著高于药物腹腔注射麻醉组（P〈O．05,P〈0．01）;水合氯醛腹腔注射组Lac含量显著高于乙醚和戊巴比妥钠麻醉组（P〈0．01）;吸人类麻醉药能较好的维持较高的PO2、SO2、O2Ct和A（肺泡气中氧分压）,而BE-ECF、BE-B、PCO2、HC03-和TCO2降低,表明不同麻醉药均有不能程度的引起大鼠静脉血血气、电解质及能量代谢产物的改变。结论不同麻醉药物均有不同程度的引起大鼠静脉血血气、电解质及能量代谢产物的改变,异氟烷和乙醚对动物机体心血管、神经系统具有一定的保护作用,机体损害较少,而戊巴比妥钠腹腔注射对动物机体心血管、神经系统具有一定的抑制作用,机体损害较大。因此,在使用麻醉药时应合理选用和控制,避免由于麻醉引起实验误差。     

Anesthetic antagonism of the effects of high hydrostatic pressure on locomotory activity of the brine shrimp Artemia

The locomotory activity of small groups of brine shrimp (Artemia salina) was studied under conditions of high hydrostatic pressure, varying temperatures and exposure to several gaseous anesthetics. Both compression and exposure to anesthesia reduced the animal's swimming activity, while temperature increased or decreased activity as it was raised or lowered from ambient. The effect of the anesthetics was less during periods of simultaneous exposure to high hydrostatic pressure. It is concluded that pressure antagonism of anesthesia is demonstrable in invertebrate organisms and may represent a fundamental interaction of these parameters in biological systems.     

Lipid protein interactions in mitochondria. VIII. Effect of general anesthetics on the mobility of spin labels in lipid vesticles and mitochondrial membranes

We have studied the effect of general anesthetics on the mobility of two stearic acid spin labels (5-doxyl stearic acid and 16-doxyl stearic acid) in bovine heart mitochondria and in phospholipid vesicles made from either mitochondrial lipids or commercial soybean phospholipids. The general anesthetics used include nonpolar compounds (alcohols, halothane, pentrane, diethyl ether, chloroform) and the amphipathic compound, ketamine. All anesthetics tested increase the mobility of the spin labels in phospholipid vesicles to a limited extent up to a concentration where the ESR spectra become those of free spin labels. On the other hand, anesthetics have a pronounced effect on mitochondrial membranes at concentrations as low as those known to produce general anesthesia; the effect is lower near the bilayer surface (5-doxyl stearic acid) and very strong in the bilayer core (16-doxyl stearic acid). The effects of anesthetics are mimicked by the detergent, Triton X-100. We suggest that the discrepancy between the action of anesthetics in mobilizing the spin labels in lipid vesicles and in membranes results from labilization of lipid protein interactions.     

DNA damage in patients who underwent minimally invasive surgery under inhalation or intravenous anesthesia

Recent studies have demonstrated the genotoxicity of anesthetics in patients who have undergone surgery and in personnel who are occupationally exposed to anesthetics. However, these findings are controversial. Herein, we used the comet assay (single-cell gel electrophoresis) to investigate the genotoxic effects of two volatile compounds [isoflurane (ISF) and sevoflurane (SVF)] that are used in inhalation anesthesia, and of one intravenous (iv) anesthetic compound [propofol (PF)]. The groups consisted of 45 patients who underwent minimally invasive surgery that lasted at least 2h. Patients were classified as physical status I using the criteria of the American Society of Anesthesiologists (ASA) and were randomly allocated to receive ISF, SVF or PF anesthesia. Venous blood samples were collected at three time points as follows: before the premedication and the induction of anesthesia (T(0)); 2h after the beginning of anesthesia (T(1)); and on the day following surgery (T(2)). DNA damage (strand breaks and alkali-labile sites) was evaluated in peripheral blood lymphocytes. For each patient, one hundred nucleoids were analyzed per time point using a semi-automated image system. Patients did not differ with respect to their demographic characteristics, the duration of surgery, or the total doses of intraoperative drugs. The amount of DNA damage was not different among the three groups before anesthesia (T(0)). No statistically significant (p>0.05) increase in DNA damage was detected during (T(1)) or after anesthesia (T(2)) using three different protocols (ISF, SVF or PF). In conclusion, general anesthesia with inhaled ISF and SVF or iv PF did not induce DNA strand breaks or alkali-labile sites in peripheral lymphocytes. Therefore, our results show that the genotoxic risk of these anesthetics, for healthy patients undergoing minimally invasive otorhinological surgery, is low or even absent.     

Sevoflurane Induces Endoplasmic Reticulum Stress Mediated Apoptosis in Hippocampal Neurons of Aging Rats

Elderly patients are more likely to suffer from postoperative memory impairment for volatile anesthetics could induce aging neurons degeneration and apoptosis while the mechanism was still elusive. Therefore we hypothesized that ER stress mediated hippocampal neurons apoptosis might play an important role in the mechanism of sevoflurane-induced cognitive impairment in aged rats. Thirty 18-month-old male Sprague-Dawley rats were divided into two groups: the sham anesthesia group (exposure to simply humidified 30–50% O₂ balanced by N₂ in an acrylic anesthetizing chamber for 5 hours) and the sevoflurane anesthesia group (received 2% sevoflurane in the same humidified mixed air in an identical chamber for the same time). Spatial memory of rats was assayed by the Morris water maze test. The ultrastructure of the hippocampus was observed by transmission electron microscopy (TEM). The expressions of C/EBP homologous protein (CHOP) and caspase-12 in the hippocampus were observed by immunohistochemistry and real-time PCR analysis. The apoptosis neurons were also assessed by TUNEL assay. The Morris water maze test showed that sevoflurane anesthesia induced spatial memory impairment in aging rats (P<0.05). The apoptotic neurons were condensed and had clumped chromatin with fragmentation of the nuclear membrane, verifying apoptotic degeneration in the sevoflurane group rats by TEM observation. The expressions of CHOP and caspase-12 increased, and the number of TUNEL positive cells of the hippocampus also increased in the sevoflurane group rats (P<0.05). The present results suggested that the long time exposure of sevoflurane could induce neuronal degeneration and cognitive impairment in aging rats. The ER stress mediated neurons apoptosis may play a role in the sevoflurane-induced memory impairment in aging rats.     

Biochemical aspects of the action of local anesthetics

Notions on the molecular mechanisms of anesthesia are presented. The chemical characteristics are given for main representatives of certain groups of local anesthetics with peculiarities of their membrane-tropic action mentioned. The effect of local anesthetics on the synaptic transmission, membrane enzymes, ion transport through the cell membranes is considered simultaneously with the anesthesia phenomenon on the basis of the data available in literature and results of the authors' investigations.     

The effect of general anesthetics on the proton and potassium permeabilities of liposomes

The pump-leak hypothesis of general anesthesia proposes that anesthetics act by increasing the functional proton permeability of membranes, particularly those of synaptic vesicles. Since transmembrane proton gradients are required for neurotransmitter accumulation, decay of such gradients by an uncompensated anesthetic-induced leak would result in loss of neurotransmitter from the vesicles, followed by synaptic block and anesthesia. We have tested this hypothesis by determining the effect of four different general anesthetics on the relative permeabilities of liposome membranes to protons and potassium ions. In all cases, physiologically relevant levels of anesthetics caused a 200 to 500 percent increment in ionic permeability. There was no marked preference for protons, suggesting that the anesthetics did not induce a leak specific for this ionic species. Instead the anesthetics appeared to produce a more general defect available to both protons and potassium ions which resulted in a functional increment in proton permeability. These observations were compared with available data on proton transport rates by synaptic vesicle ATPase enzymes. The magnitude of the anesthetic-induced leak could not be compensated by the ATPase, which is only capable of a 40 percent increase in rate when uncoupled. We consider these results to be consistent with the pump-leak hypothesis.     

Neurotoxic effects of local anesthetics on the mouse neuroblastoma NB2a cell line

Abstract

Local anesthetics are used clinically for peripheral nerve blocks, epidural anesthesia, spinal anesthesia and pain management; large concentrations, continuous application and long exposure time can cause neurotoxicity. The mechanism of neurotoxicity caused by local anesthetics is unclear. Neurite outgrowth and apoptosis can be used to evaluate neurotoxic effects. Mouse neuroblastoma cells were induced to differentiate and generate neurites in the presence of local anesthetics. The culture medium was removed and replaced with serum-free medium plus 20 μl combinations of epidermal growth factor and fibroblast growth factor containing tetracaine, prilocaine, lidocaine or procaine at concentrations of 1, 10, 25, or 100 μl prior to neurite measurement. Cell viability, iNOS, eNOS and apoptosis were evaluated. Local anesthetics produced toxic effects by neurite inhibition at low concentrations and by apoptosis at high concentrations. There was an inverse relation between local anesthetic concentrations and cell viability. Comparison of different local anesthetics showed toxicity, as assessed by cell viability and apoptotic potency, in the following order: tetracaine > prilocaine > lidocaine > procaine. Procaine was the least neurotoxic local anesthetic and because it is short-acting, may be preferred for pain prevention during short procedures.     

The pharmacokinetic interaction of diethyl ether with aminopyrine in the rat

Our studies in rats clearly demonstrate a significant depression of aminopyrine metabolism in vivo by ether anesthesia. The depression of aminopyrine elimination was shown both by measurements of plasma aminopyrine clearance and by depression of the [14C]aminopyrine breath test. No apparent effect of ether was seen on aminopyrine volume of distribution. The effect of ether was prolonged, as judged by its persistence in the aminopyrine breath test for 3 hr after stopping ether anesthesia. In addition, when ether was administered in combination with a single dose of ethanol, aminopyrine clearance was inhibited significantly more than with ethanol alone. These data not only have a bearing on proper methodologic design of drug clearance studies but also may relate to the effects of some anesthetics on hepatic function.