The Experts below are selected from a list of 474 Experts worldwide ranked by ideXlab platform
Kyungjin Yeum - One of the best experts on this subject based on the ideXlab platform.
-
isoflurane and propofol contribute to increasing the antioxidant status of patients during minor elective surgery a randomized clinical study
Medicine, 2015Co-Authors: Mariana Gobbo Braz, Leandro Gobbo Braz, Cristiana M M Freire, Lorena M C Lucio, Jose Reinaldo Cerqueira Braz, Guangwen Tang, Daisy Maria Favero Salvadori, Kyungjin YeumAbstract:Isoflurane is a volatile Halogenated Anesthetic used especially for anesthesia maintenance whereas propofol is a venous Anesthetic utilized for anesthesia induction and maintenance, and reportedly an antioxidant. However, there are still controversies related to isoflurane-induced oxidative stress and it remains unanswered whether the antioxidant effects occur in patients under propofol anesthesia.Taking into account the importance of better understanding the role of Anesthetics on oxidative stress in anesthetized patients, the present study was designed to evaluate general anesthesia maintained with isoflurane or propofol on antioxidant status in patients who underwent minimally invasive surgeries.We conducted a prospective randomized trial in 30 adult patients without comorbidities who underwent elective minor surgery (septoplasty) lasting at least 2 h admitted to a Brazilian tertiary hospital.The patients were randomly allocated into 2 groups, according to anesthesia maintenance (isoflurane, n = 15 or propofol, n = 15). Peripheral blood samples were drawn before anesthesia (baseline) and 2-h after anesthesia induction.The primary outcomes were to investigate the effect of either isoflurane or propofol anesthesia on aqueous plasma oxidizability and total antioxidant performance (TAP) by fluorometry as well as several individual antioxidants by high-performance liquid chromatography. As secondary outcome, oxidized genetic damage (7,8-dihydro-8-oxoguanine, known as 8-oxo-Gua) was investigated by the comet assay.Both anesthesia techniques (isoflurane or propofol) for a 2-h period resulted in a significant decrease of plasma α-tocopherol, but not other antioxidants including uric acid, carotenoids, and retinol (P > 0.05). Propofol, in contrast to isoflurane anesthesia, significantly increased (P < 0.001) anti-inflammatory/antioxidant plasma γ-tocopherol concentration in patients. Both anesthesia types significantly enhanced hydrophilic antioxidant capacity and TAP, with no significant difference between them, and 8-oxo-Gua remained unchanged during anesthesia in both groups. In addition, both Anesthetics showed antioxidant capacity in vitro.This study shows that anesthesia maintained with either propofol or isoflurane increase both hydrophilic and total antioxidant capacity in plasma, but only propofol anesthesia increases plasma γ-tocopherol concentration. Additionally, both types of Anesthetics do not lead to oxidative DNA damage in patients without comorbidities undergoing minimally invasive surgery.
Noel R Rose - One of the best experts on this subject based on the ideXlab platform.
-
suppressive and pro inflammatory roles for il 4 in the pathogenesis of experimental drug induced liver injury
European Journal of Immunology, 2009Co-Authors: Dolores B Njoku, Nicole D Washington, Jenelle L Mellerson, Monica V Talor, Rajni Sharma, Noel R RoseAbstract:The pathogenesis of immune-mediated drug-induced liver injury (DILI) following Halogenated Anesthetics, carbamazepine or alcohol has not been fully elucidated. Detecting cytochrome P450 2E1 (CYP2E1) IgG4 auto-antibodies in Anesthetic DILI patients suggests a role for IL-4 in this hapten-mediated process. We investigated IL-4-mediated mechanisms using our model of experimental DILI induced by immunizing BALB/c (WT) and IL-4(-/-) (KO) mice with S100 liver proteins covalently modified by a trifluoroacetyl chloride (TFA) hapten formed following Halogenated Anesthetic metabolism by CYP2E1. WT mice developed more hepatitis, TFA and S100 antibodies (p<0.01), as well as T-cell proliferation to CYP2E1 and TFA (p<0.01) than KO mice. Additionally, WT CD4(+) T cells adoptively transferred hepatitis to naive Rag(-/-) mice (p<0.01). Pro-inflammatory cytokines were expectedly decreased in TFA hapten-stimulated KO splenocyte supernatants (p<0.001); however, IL-2 and IFN-gamma (p<0.05), as well as IL-6 and IL-10 (p<0.001) levels were elevated in CYP2E1-stimulated KO splenocyte supernatants, suggesting dual IL-4-mediated pro-inflammatory and regulatory responses. Anti-IL-10 administered to KO mice increased hepatitis, TFA and CYP2E1 antibodies in KO mice confirming a critical role for IL-4. This is the first demonstration of dual roles for IL-4 in the pathogenesis of immune-mediated DILI by suppressing auto-antigen-induced regulatory responses while promoting hapten-induced pro-inflammatory responses.
Abbas Jafari - One of the best experts on this subject based on the ideXlab platform.
-
Occupational Exposure to Anesthetic Waste Gases in Operating Rooms: a Need to Revise Occupational Exposure Limits in Iran
Shahid Sadoughi University of Medical Science Yazd Iran, 2018Co-Authors: Mohammad Hajaghazadeh, Abbas JafariAbstract:A nesthetic gases were developed in the 17th century and nowadays are widely used for the general anesthesia in the operating rooms (ORs).1 Anesthetic agents, especially Halogenated Anesthetics and nitrous oxide (N2O), can contaminate the ambient air of the ORs and therefore occupational exposure to these gases is a common occupational hazard. The anesthesia machine leakage, inadequate scavenging system and exhalation of the patient are the major causes of exposure to Anesthetic wastes in ORs.2The emission of Anesthetic gases into the atmosphere of ORs could be minimized by different approaches such as engineering and administrative controls. Different adverse health effects including neurobehavioral changes, fatigue, headaches, dizziness, lethargy, memory problems have been reported as the result of exposure to trace levels of waste Anesthetic gases.3-5 According to much of the supportive evidence derives from animal studies, the chronic exposure to these agents have linked to liver and kidney damage, genotoxicity, spontaneous abortion, and congenital malformations.5,6 Personal exposure assessment of Anesthetic gases includes biological and breathing zone air monitoring. ACGIH did not set any biological exposure index (BEI) for Anesthetic gases. Some researchers investigated the urinary concentration of unmetabolised Anesthetic agents or their metabolites. For example, the urinary concentrations of sevoflurane and hexafluoro-isopropanol (HFIP) have been investigated in the occupationally exposed personnel.7,8 In the studies in which the concentration of breathing zone and urinary concentration of Anesthetic agent has been correlated, a biological equivalent limit corresponding to the established OEL has been suggested. For example, Jafari et al. found biological equivalent limit of 3.61 µg/lurine for 2 ppm environmental exposure of isoflurane. Similar values have also reported as biological equivalent limit for isoflurane by other researchers.9 Further studies are needed to establish BEI for Anesthetic agents. To monitoring air quality in ORs, portable direct reading instruments and sample collection device methods are utilized. For instance, a photo-acoustic infrared spectrometry analyzer has been used for direct reading of Halogenated and N2O in ORs.10 Time-integrated air samples could be collectedeither by adsorption tubes connected to a pump or by passive dosimeters.9 Different values have been set as OELs of Anesthetic gases. For example, NIOSH recommended that the concentration of a Halogenated Anesthetic agent during its administration should be less than 2 ppm if it is used alone or below 0.5 ppm if it is used in combination with nitrous oxide. The NIOSH REL for N2O is 25 ppm.6,11 At present, OSHA does not have PEL for Anesthetic agents. ACGIH has set TLVs only for enflurane, halothane, and nitrous oxide as 75, 50, and 50 ppm respectively. The Iran Ministry of Health and Medical Education has set OELs of desflurane and sevoflurane as 20 ppm; N2O, isoflurane and halothane as 50 ppm; and enflurane as 75 ppm. It seems that in the absence of any TLV (by ACGIH) or PEL (by NIOSH) for isoflurane, desflurane and sevoflurane and considering the REL of 2 ppm for any Halogenated Anesthetic agents, the Iran OELs of desflurane, sevoflurane, and isoflurane might be used with caution. It is worth mentioning that in ORs of Iran, N2O is commonly used in combination with isoflurane and sevoflurane. Therefore, the reduction in OELs of these Halogenated agents, similar to NIOSH REL, would be proposed. The OEL of halothane could alsobeintheforefrontofchange, since the hepatotoxicity of this agent has been reported.12 As a conclusion, the occupational exposure to Anesthetic waste gases should be monitored periodically to protect the personnel of ORs and in the assessment of monitoring results, specific attention should be paid to concurrent use of N2O and Halogenated Anesthetic gases. Importantly, in the future revise of OELs by Iran Ministry of Health and Medical Education the concerns addressed here would be considered helpful.
Mulvenon, Andrea R - One of the best experts on this subject based on the ideXlab platform.
-
Occupational exposure to isoflurane Anesthetic gas in the research environment
DigitalCommons@UNMC, 2015Co-Authors: Mulvenon, Andrea RAbstract:This dissertation is a compilation of studies related to the Halogenated Anesthetic gas isoflurane. Historically, Halogenated Anesthetic gases have been used in the health care industry. In 1977 the National Institute for Occupational Safety and Health (NIOSH) issued a recommended exposure limit (REL) of two parts per million (ppm) averaged over one hour of exposure for Halogenated Anesthetic gases (NIOSH 1977). The purpose of the standard was to protect healthcare workers from exposure to halothane, methoxyflurane, and chloroform. However, isoflurane only became available after the NIOSH REL was adopted. Therefore, the NIOSH REL is not directly applicable to isoflurane. Moreover, use of isoflurane in healthcare has diminished over the years, and it is now more widely used in medical research laboratories and veterinary clinics. The purpose of this dissertation is to demonstrate the need for an updated occupational exposure limit for isoflurane. Four studies were conducted toward the completion of this goal; a systematic review of the literature to investigate human health effects associated with occupational exposure to isoflurane, a case study of a high exposure to isoflurane and its control, an assessment of occupational exposure of isoflurane to researchers, and a comparison of the effectiveness of control methods in reducing isoflurane waste Anesthetic gas (WAG). In the first study, we searched the PubMed and Embase databases were searched for articles with data on health effects associated with occupational isoflurane exposure. Thirteen studies were found during the search that fit the review criteria. Five of the studies reported no adverse human health effects. Eight of the studies reported human health effects ranging from genetic mutations, changes in cellular function, symptoms of acute exposure, and congenital anomalies in the offspring of exposed women. In the second study, we found that researchers working with isoflurane in a small unventilated space had exposures close to 30 ppm over a short-time period (0.48 and 1.15 hours) for the main researcher. Other members of the group had exposures above 2 parts per million (ppm). An active scavenging ventilation control which reduced isoflurane exposure by an average of 86%. In the third study, we showed that isoflurane exposure to researchers at a medical research institution was significantly associated with scavenging technique and role of the investigator (p = 0.02 and 0.04, respectively). Researchers using passive scavenging canisters were exposed to a mean concentration of 3.18 ppm (%CV = 123) and researchers using active scavenging were exposed to a mean isoflurane concentration of 0.83 ppm (% CV = 89). Researchers who performed the greater part of the procedures were exposed to a mean of 2.71 ppm (%CV = 108) and researchers who assisted were exposed to a mean of 1.18 ppm (%CV = 97). In the final study, we evaluated isoflurane exposures when using active scavengers, passive canister scavengers, and combinations of both scavenging techniques. We also evaluated isoflurane exposures with no scavenging control. Isoflurane concentration was significantly associated with control method (p \u3c 0.0001). Post hoc Tukey’s comparison showed the significant difference (p = 0.05) in isoflurane concentration between no scavenging and active scavenging conditions, no scavenging and combination active and passive scavenging conditions, and passive and active scavenging conditions. There was no difference between no scavenging and passive scavenging conditions or active scavenging and combination scavenging conditions. The mean isoflurane concentration while using no scavenging controls was 10.23 ppm (%CV = 12), and was 10.35 ppm (%CV = 58) while using passive scavenging. Isoflurane concentration using active scavenging was 1.43 ppm (%CV = 15) and 0.59 ppm (%CV = 46) while using the combination scavenging method. Researchers who use passive scavenging methods are more likely to be at risk for isoflurane exposure above 2 ppm. Researchers should use active scavenging to control isoflurane WAG
Mariana Gobbo Braz - One of the best experts on this subject based on the ideXlab platform.
-
isoflurane and propofol contribute to increasing the antioxidant status of patients during minor elective surgery a randomized clinical study
Medicine, 2015Co-Authors: Mariana Gobbo Braz, Leandro Gobbo Braz, Cristiana M M Freire, Lorena M C Lucio, Jose Reinaldo Cerqueira Braz, Guangwen Tang, Daisy Maria Favero Salvadori, Kyungjin YeumAbstract:Isoflurane is a volatile Halogenated Anesthetic used especially for anesthesia maintenance whereas propofol is a venous Anesthetic utilized for anesthesia induction and maintenance, and reportedly an antioxidant. However, there are still controversies related to isoflurane-induced oxidative stress and it remains unanswered whether the antioxidant effects occur in patients under propofol anesthesia.Taking into account the importance of better understanding the role of Anesthetics on oxidative stress in anesthetized patients, the present study was designed to evaluate general anesthesia maintained with isoflurane or propofol on antioxidant status in patients who underwent minimally invasive surgeries.We conducted a prospective randomized trial in 30 adult patients without comorbidities who underwent elective minor surgery (septoplasty) lasting at least 2 h admitted to a Brazilian tertiary hospital.The patients were randomly allocated into 2 groups, according to anesthesia maintenance (isoflurane, n = 15 or propofol, n = 15). Peripheral blood samples were drawn before anesthesia (baseline) and 2-h after anesthesia induction.The primary outcomes were to investigate the effect of either isoflurane or propofol anesthesia on aqueous plasma oxidizability and total antioxidant performance (TAP) by fluorometry as well as several individual antioxidants by high-performance liquid chromatography. As secondary outcome, oxidized genetic damage (7,8-dihydro-8-oxoguanine, known as 8-oxo-Gua) was investigated by the comet assay.Both anesthesia techniques (isoflurane or propofol) for a 2-h period resulted in a significant decrease of plasma α-tocopherol, but not other antioxidants including uric acid, carotenoids, and retinol (P > 0.05). Propofol, in contrast to isoflurane anesthesia, significantly increased (P < 0.001) anti-inflammatory/antioxidant plasma γ-tocopherol concentration in patients. Both anesthesia types significantly enhanced hydrophilic antioxidant capacity and TAP, with no significant difference between them, and 8-oxo-Gua remained unchanged during anesthesia in both groups. In addition, both Anesthetics showed antioxidant capacity in vitro.This study shows that anesthesia maintained with either propofol or isoflurane increase both hydrophilic and total antioxidant capacity in plasma, but only propofol anesthesia increases plasma γ-tocopherol concentration. Additionally, both types of Anesthetics do not lead to oxidative DNA damage in patients without comorbidities undergoing minimally invasive surgery.
