Intraoperative multi-pulse transcranial electric stimulation: the effect of general anesthetics impact on the excitability of the pyramidal tract

2020 ◽  
Vol 22 (4) ◽  
pp. 47-52
Author(s):  
O. A. Toporkova ◽  
M. V. Aleksandrov ◽  
R. V. Nazarov ◽  
V. S. Chernyj
Keyword(s):  
Electrical Stimulation ◽  
Motor Neuron ◽  
General Anesthesia ◽  
Neurophysiological Monitoring ◽  
Transcranial Electrical Stimulation ◽  
General Anesthetics ◽  
General Anesthetic ◽  
Periodic Patterns ◽  
Stimulation Current ◽  
Alpha Motor Neuron

The results of intraoperative neurophysiological monitoring during neurosurgical treatment of pathological processes in the central nervous system are analyzed. The mechanisms of action of general anesthetics on the excitability of the pyramidal system during anesthesia with propofol and sevoflurane have been clarified. It has been established that anesthetics with different mechanisms differ in their effect on excitability and conductivity in the system motor neuron of the cortex pathways alpha-motor neuron. Inhalation anesthetic sevoflurane causes a slowdown in the conduction of a nerve impulse and a violation of the mechanisms of convergence of excitation on the alpha-motor neuron of the spinal cord. In this regard, during general anesthesia with sevoflurane, in order to achieve the effectiveness of transcranial electrical stimulation, the number of stimuli in the package should be increased first with a relatively high stimulation current. Under general anesthesia with propofol, the processes of convergence of excitation are not inhibited, therefore, effective electrical stimulation is achieved by increasing the stimulation current with a stable number of stimuli. With an increase in doses of general anesthetic to a level at which periodic patterns are recorded on the electroencephalogram, a deep inhibition of the excitability and conductivity of the pyramidal system occurs. Under these conditions, effective performance of transcranial electrical stimulation is achieved with submaximal values of the current strength and the number of stimuli.

Abstract T P111: General Anesthetic Use and Clopidogrel Resistance During Neurovascular Stenting Procedures

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yamin Shwe ◽  
Santiago Ortega-Gutierrez ◽  
David Altschul ◽  
Jinu Kim ◽  
Karen Chen ◽  
...  
Keyword(s):  
Cytochrome P450 ◽  
General Anesthesia ◽  
Retrospective Chart Review ◽  
Bleeding Risk ◽  
Cytochrome P450 Monooxygenases ◽  
General Anesthetics ◽  
General Anesthetic ◽  
Intracranial Stenting ◽  
Clopidogrel Resistance ◽  
Post Procedure

Purpose: To determine the effect of general anesthesia on clopidogrel resistance among patients undergoing intracranial stenting procedures Background: Clopidogrel resistance is associated with increased periprocedural thromboembolic complications in neurovascular stenting procedures. Clopidogrel is metabolized by cytochrome P450 system to an active drug that irreversibly binds to the platelet ADP receptor P2Y12 and inhibits downstream platelet aggregation. General anesthetics are commonly used in intracranial stenting procedures and are known to inhibit cytochrome P450 monooxygenases. Therefore we hypothesized that the use of common general anesthetics would be associated with increased clopidogrel resistance. Methods: We conducted a retrospective chart review of 41 patients who underwent intracranial stenting and coiling procedures under general anesthesia from 2010-2013. We analyzed the 35/41 who had platelet assays performed within twenty-four hours both before and after the procedure (VerifyNow, Accumetrics, Inc., San Diego, CA, USA). P2Y12 reaction unit (PRU) was used to measure platelet resistance, with values ≤178 indicating increased bleeding risk, 179-238 therapeutic, and ≥239 thrombogenic. Pre-procedural and post-procedural mean PRU values were compared using t tests to determine the effect of general anesthesia on clopidogrel resistance. Results: We found significantly increased post-procedure PRUs compared to pre-procedure PRUs. Mean PRU twenty-four hours before procedure was 214±34 (95% CI 180-248) compared with 260±25.24 (95% CI 235-285) twenty-four hours after the procedure (p<0.05). Out of 35 patients, 27 (77%) had increased PRUs post- procedure compared to pre-procedure. Conclusion: Clopidogrel resistance is increased following endovascular stenting procedures. We propose that this occurs through competitive interaction with CYP isoforms by general anesthetics. We are not aware of any prior studies demonstrating an association between general anesthetics and clopidogrel resistance. Further prospective studies are needed to further define this observation.

Does general anesthesia affect neurodevelopment in infants and children?

BMJ ◽  
2019 ◽  
pp. l6459 ◽  
Author(s):  
Mary Ellen McCann ◽  
Sulpicio G Soriano
Keyword(s):  
General Anesthesia ◽  
Pediatric Anesthesia ◽  
Neuronal Cell ◽  
Abnormal Development ◽  
In Vivo Studies ◽  
General Anesthetics ◽  
Neurocognitive Deficits ◽  
General Anesthetic

AbstractGeneral anesthesia has been unequivocally linked to abnormal development of the central nervous system, leading to neurocognitive impairments in laboratory models. In vitro and in vivo studies have consistently shown that exposure to GABA agonists (eg, volatile anesthetics, midazolam, and propofol) or NMDA antagonists (eg, ketamine, isoflurane, and nitrous oxide) produces dose dependent and developmental age dependent effects on various neuronal transmission systems. Exposure to these drugs increases neuronal cell death in juvenile animals including rats, mice, and non-human primates. The possibility of anesthetic induced neurotoxicity occurring in children has led to concerns about the safety of pediatric anesthesia. A spectrum of behavioral changes has been documented after general anesthetic exposure in young children, including emergence delirium, which may be evidence of toxicity. Most clinical studies are retrospective; specifics about medications or monitoring are unavailable and many of the outcomes may not be sensitive to detect small neurocognitive deficits. Some of these retrospective studies have shown an association between anesthesia exposure at a young age and neurocognitive deficits, but others have not. Practitioners and families should be reassured that although general anesthetics have the potential to induce neurotoxicity, very little clinical evidence exists to support this.

Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

2016 ◽  
Vol 21 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Silvia Convento ◽  
Cristina Russo ◽  
Luca Zigiotto ◽  
Nadia Bolognini
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Rehabilitation ◽  
Cognitive Disorders ◽  
Spatial Neglect ◽  
Transcranial Electrical Stimulation ◽  
Clinical Settings ◽  
Post Stroke ◽  
Neuropsychological Disorders ◽  
Current State ◽  
Stimulation Technique

Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.

scholarly journals General anesthesia with remimazolam in a patient with mitochondrial encephalomyopathy: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Matsuyuki Doi ◽  
Yoshiki Nakajima
Keyword(s):  
Lactic Acidosis ◽  
General Anesthesia ◽  
Mitochondrial Disease ◽  
Muscle Relaxation ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Mitochondrial Encephalomyopathy ◽  
Anesthesia Induction ◽  
General Anesthetic ◽  
Anesthetic Agents

Abstract Background Systemic anesthetic management of patients with mitochondrial disease requires careful preoperative preparation to administer adequate anesthesia and address potential disease-related complications. The appropriate general anesthetic agents to use in these patients remain controversial. Case presentation A 54-year-old woman (height, 145 cm; weight, 43 kg) diagnosed with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes underwent elective cochlear implantation. Infusions of intravenous remimazolam and remifentanil guided by patient state index monitoring were used for anesthesia induction and maintenance. Neither lactic acidosis nor prolonged muscle relaxation occurred in the perioperative period. At the end of surgery, flumazenil was administered to antagonize sedation, which rapidly resulted in consciousness. Conclusions Remimazolam administration and reversal with flumazenil were successfully used for general anesthesia in a patient with mitochondrial disease.

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